Ten days from now will be the 205th anniversary of the birth of Abraham Lincoln, arguably the greatest and most famous American who ever lived. I’m sure you’ll be deluged with Lincolniana on the anniversary, and all of that just testifies to the fact that Americans will never tire of Lincoln history, stories or analysis. Among every other aspect of Lincoln’s life that has been analyzed and hashed over again and again is his physical health. Recently, however, I came across an interesting theory that, unlike other suppositions about Lincoln’s health, seems to have evidence to support it: the Great Emancipator may have been dying of cancer at the time John Wilkes Booth’s bullet changed American history for the worse.

This is the theory put forth in a 2008 book by Dr. John G. Sotos called The Physical LincolnI have not read this book, but for years I’ve been a great fan of Dr. Sotos’s website “Medical History of US Presidents,” where he posts as Dr. Zebra and provides many fascinating tidbits about the physical health of our chief executives and where his conclusions are discussed. (Dr. Sotos’s work inspired my recent article on James Buchanan’s “National Hotel Disease.”) Dr. Zebra makes a pretty convincing argument that Lincoln was indeed suffering from cancer. He says that Lincoln may have had a rare type of cancer called multiple endocrine neoplasia type 2B (MEN2B). This is a cancer that affects the thyroid and adrenal glands. It is an extremely rare form of cancer.

Where’s the evidence? Cancer is evidently inevitable in people who have the MEN2B condition. There is apparently some genetic evidence that this condition ran in Lincoln’s family. As for Lincoln himself, the famous mole on the side of his face, his high voice, the looseness of his joints, the way he would often lie down while reading–all are consistent with people who have this rare condition.

lincoln 1863

Here is how Abraham Lincoln looked in November 1863, the time of the Gettysburg Address. Contrast it with the picture at the top of this article and you can see how he went downhill in his last 18 months.

More convincingly, if you look at the evidence it seems likely that Lincoln was suffering from something in his final year, and not just the incredible strain of the Civil War. The famous Alexander Gardner photo of him from 1865, taken shortly before his death (it’s at the top of this article) depicts a very gaunt-looking, almost sickly man. Lincoln was always tall, thin and bony, but he began losing weight prodigiously in 1860 when he was elected President, and observers at his autopsy and funeral were shocked at the wasted appearance of his body and his sunken chest. Furthermore, in his final year Lincoln complained often of headaches, fainting spells and coldness of his hands and feet. The terrible effects of whatever he had are particularly marked when you examine photos of him taken in 1864 and then a year later. The Great Emancipator was literally wasting away.

You don’t hear this often observed of Lincoln. The most famous “historical diagnosis” of Lincoln that I’m familiar with–besides depression, which Dr. Sotos seems to distrust–is that he might have had a condition called Marfan’s Syndrome, which accounts for his strange proportions and his elongated hands and feet. Medical experts are evidently split on whether the evidence is there to suggest Lincoln had this condition. Dr. Sotos thinks he didn’t. I’ve never been very persuaded by “historical diagnoses” anyway; more often than not such assertions are merely stunts to sell books. Dr. Sotos’s conclusions, however, seem more grounded than the majority of those types of backwards-looking conclusions.

If Lincoln was indeed dying of cancer–and likely didn’t know it–when he went to Ford’s Theater that night in April 1865, it presents an interesting historical situation: one where a momentous, history-changing event might not have been as momentous as it seems. John Wilkes Booth’s assassination of Lincoln was undoubtedly a big deal and it may have helped enshrine Lincoln as a national hero. But if he had died early in his second term anyway, would the history of Reconstruction have been that different? Andrew Johnson would still have taken over as President; presumably the epic battles he had with Congress would have occurred anyway, perhaps later. Who knows? It’s an interesting rumination.

We’ll never know, of course, and in one sense I suppose it doesn’t matter. But it’s interesting and eye-opening to think about yet another possible agony in the life of a man who know so much pain and hardship in his life, and who has become a symbol for our own national agony in the Civil War. The suggestion that he may have been dying at the time seems almost poignant.