Why Lincoln fell gravely ill after delivering his Gettysburg Address

May 17, 2007

Many school children in the United States memorize President Abraham Lincoln's Gettysburg Address, considered one of history's most brilliant speeches and a model of brevity and persuasive rhetoric.

But according to two medical researchers at University of Texas Medical Branch at Galveston, most historians have failed to recognize that when Lincoln delivered it on Nov. 19, 1863, he was in the early stages of a life-threatening illness — a serious form of smallpox. Their report appears in the current issue of Journal of Medical Biography, a scholarly quarterly published by the Royal Society of Medicine Press in London.

Almost a third of those contracting this serious form of smallpox in the mid-19th century died, the researchers said.

Some of those historians who recognized that Lincoln was ill following his Gettysburg speech asserted that he was suffering from a very mild form of smallpox, one that occurs in previously immunized individuals, the researchers wrote. However, the researchers ascertained that his illness was the far more serious form of smallpox that occurs in non-immunized people.

To reach that conclusion, the researchers contrasted the clinical features of Lincoln's illness as cited in a host of sources with the manifestations of smallpox, of the milder form of smallpox that occurs in immunized people and of the most common diseases with symptoms that mimic smallpox.

"The serious form of smallpox, known as variola major, was the only disease that closely fit Lincoln's clinical features: high fever, weakness, severe pain in the head and back, prostration, skin eruption — plus the severity and approximately 21-day duration of Lincoln's illness," said Dr. Armond S. Goldman, an emeritus professor in the Department of Pediatrics at UTMB and lead author of the study.

"Smallpox was rampant in the United States at that time," Goldman noted. "In addition, although immunization against smallpox was practiced in the mid-19th century, there is no historical evidence that Lincoln was immunized against smallpox before his illness." Moreover, Goldman said, "The milder form of smallpox, known as variola minor, first appeared in the United States at the turn of the 20th century and was unknown in the United States during the mid-19th century when Lincoln became ill."

"Lincoln's physicians attempted to reassure him that his disease was a mild form of smallpox," Goldman noted, "but that may have been to prevent the public from fearing that Lincoln was dying."

Such fears, however, would have been well-founded: If Lincoln had the variola major form of smallpox, "there was at least a 30 percent chance that he could have died," Goldman said.

Fortunately, 25 days after the start of his illness, Lincoln was able to return to his full duties and led the country to a successful conclusion to the Civil War in 1865, a reunification of the North and South and an end of slavery in the United States. "His death due to smallpox would have undoubtedly changed the subsequent history of the country," Goldman noted. "At the least, the goals that were attained during the rest of Lincoln's presidency would have been obtained less rapidly and perhaps less completely."

According to a physician's contemporary account reported in the paper, Lincoln retained his trademark wry and sometimes black sense of humor despite his illness. When Dr. Washington Chew Van Bibber of Baltimore contradicted earlier diagnoses that the president had a cold and "bilious fever" and, using an old-fashioned name for smallpox, told Lincoln he had "a touch of the varioloid," a colleague of Van Bibber later wrote in his memoirs that the president responded: "Then am I to understand that I have the smallpox?"

When Van Bibber acknowledged that the president did have that highly infectious disease, Lincoln is said to have responded: "How interesting. I find every now and then that even unpleasant situations in life have certain compensation. As you came in just now, did you pass through the waiting room?"

Van Bibber responded, "I passed through a room full of people."

"Yes, that's the waiting room," Lincoln is reported to have said, "and it's always full of people. Do you have any idea what they are there for?"

"Well, perhaps I could guess," the doctor replied.

"Yes," said Lincoln, "they are there, every mother's son of them, for one purpose only: namely, to get something from me. For once in my life as president, I find myself in a position to give everybody something!"

Goldman said that he and his co-investigator, Dr. Frank C. Schmalstieg, also of UTMB, hope that their findings will encourage future historians to recognize in their writings the nature and gravity of Lincoln's Gettysburg illness.

Source: University of Texas Medical Branch at Galveston

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