Mary Lincoln's Health

A much-discussed controversy

Photo by Hush Naidoo Jade Photography on Unsplash

The state of Mary Lincoln’s physical and mental health was much-debated in the latter years of her life, and in modern times a small industry has sprung up around analyzing her condition and proffering diagnoses.

I have written a bit about this in the past, such as the article below, when I speculated that a severe head injury she had suffered in 1863 that led to an infection had also led to lifelong episodes of pain and possibly also cognitive problems.

Several physicians had prescribed for this afflicted lady, without success, having misunderstood her symptoms. But Dr. Dake, with his rare perception, gave an accurate diagnosis at the first interview, telling Mrs. Lincoln that she was suffering from the effects of as severe concussion on the head, and finally drew from the lady the fact that she was, shortly before her husband’s tragic death, violently thrown from her carriage by conspirators, who intended thereby to kill the President, but who escaped unhurt.

It has been speculated that Mary Lincoln was actually suffering from neurosyphilis in 1881-1882, given her symptoms and the behavior of herself and the doctors involved in diagnosing and treating her.¹ There appears to be merit to claims that reports her back and limb problems at this time were the result of a falling from a chair onto a table while still in France in 1879 did not tell the entire story, but the jump from that to suspecting it was all a cover story for late-stage tertiary syphilis symptoms strikes me as unfounded.

While this cannot be proven, the most likely explanation is that exaggerating the centrality of an 1879 back injury was one of Mary’s old strategies, given she’d been—at times—complaining of the same symptoms from the day she requested a pension in 1868. At that time, she did not base her claim on the need for sustenance—she never denied she possessed the means to live, however much time has been spent refuting imaginary claims of destitution. She grounded her claim in her ill health, dwelling on medical bills, the cost of visiting health spas, and the need for a servant, maid, or nurse to assist her. She needed to offer some sort of explanation because by then it was clear that her status as Lincoln’s widow was not sufficient.

This does not mean that Mary lied about her condition or feigned illness. The evidence shows that some of these symptoms were real, and does not show that any were fabricated. The relevant point is that during her pension campaign, she based the bulk of her arguments around her health, and emphasized her condition accordingly. Jason Emerson[2] addressed the attention-seeking aspect, suggesting she suffered from a combination of real ailments and hypochondria. I argue that much of it was not the result of psychological dysfunction, but instead the result of calculated attention-seeking for the purposes of sympathy and expedience. Hypochondria appears to have been present as well, but she never seemed to let it hold her back.

When Mary was not agitating for money, she spoke of her health less often, most notably between June 1875 and some point in 1879, when she was not seeking financial compensation and rather averse to public attention. She may have been in no better condition than before—it could be that she said little because she thought it useless to worry or annoy her friends and family with health complaints about which they could do nothing. It could also be that her symptoms (or awareness of them) worsened when she was stressed about her finances. It was likely a combination of the two. Whether or not her symptoms resulted in part from hypochondria, it is undeniable that she used them for dramatic effect.

By this, I mean Mary was creative in staging the scenes in which her health prolems featured prominently. In December 1869 she wrote to Sally One about another indication of malicious interference with her life—a Maine newspaper’s cruel satirical portrayal of her engagement to a European count, gleefully published to a wide audience by the hostile New York World. The malice continued as papers republished selections; the lack of context made it appear credible instead of cruel, with the count’s intentionally absurd name morphing into a more plausible one. This made it worse, as it reached a form in which publications relayed it as another current report, no malicious individuals needed. The resulting international publicity notified Mary of her impending marriage to a Baden Count. “The same evil spirit, that originated this rumor last spring, is evidently again at work,” she wrote, noting that it coincided with Congress’s consideration of her pension.

She showed her capacity for restraint in the one dignified sentence she sent to Sally for publication: “Mrs. Lincoln sees no gentlemen.” Their mutual friend, editor John W. Forney, allowed her to use the Philadelphia Press as her mouthpiece. She did not lash out—in fact, she knew that any response longer than that would only draw more attention. But among her allies in her pension campaign, she played it up. Emphases added.

In this letter to Sally, she explicitly connected the press attack with her health: “I passed a sleepless, miserable night . . . I have a fever upon me—with great & burning pain in my spine—with no one near me to hand me a glass of water—If I was dying.” That she was alone was true, and if she was dying, it would have been a disturbing situation. But this was clearly a hypothetical, so she was in no danger going without water. It is difficult to imagine a situation in which Mary would have let things deteriorate to the point where she (or her children) would have gone without actual necessities, let alone a glass of water.

In June 1867, she wrote to David Davis to let him know that since she last saw him, the stress over paying for her house had caused such illness that, due to physicians bills, she had given up housekeeping. The Lincolns had just been summoned as witnesses in the trial of one of Booth’s conspirators. Tad and Robert went, but she pled illness. “Of course,” she told Davis, “as I have been scarcely able to leave my lounge, I declined.— Robert & Taddie, went on—and I am expecting their daily return—I came up to Racine, to see something about the school here.” That she had made it from her lounge to Wisconsin is not how you thought that sentence would end!

In terms of her actual health, we must realize that people at the time were riddled with infections for which there was no treatment. Malaria was ubiquitous in the summer, and many people suffered from things they called “nervous fever,” or “brain fever,” which sometimes referred to typhoid fever, known for its delirium, but other times was associated with mental distress. People unaware of this may read letters and diaries and come away with the idea that hypochondriacs were rampant. Health issues were plentiful, and the lack of understanding around certain symptoms at the time can make their claims sound even stranger.

It is hard to analyze medical claims about Mary Lincoln, or anyone of her era, because the understanding of medicine was very different. By that I do not mean simply that they did not have modern knowledge and technology, but that they had their own theories and practices. It is one thing to not know how to address a medical condition; it is another to erroneously believe you do understand and act accordingly. In the absence of modern accreditation and other processes, the level of a doctor’s knowledge could vary widely. Much of this probably depended on the individual doctor’s intuitive reasoning and experience. It was only in 1880 that New York made registration mandatory for physicians, in response to increasing complaints about “quacks.” “Originally, the process of registration was to be complete by late 1880 but the period was extended to October 1881”—exactly when Mary Lincoln arrived in New York. Surely,[3] the elimination of incompetent doctors did not happen immediately.

Because people of that era believed in conditions and mechanisms that we now know to be false and view as bizarre, it is hard to translate their conclusions into modern terms. More than this, it must be remembered that many things we may never see or which would be no big deal to us were very much a problem then. Many people suffered from conditions, often progressive ones, which most people today have never seen beyond the initial stages. Comparably few people today have seen an untreated diabetic, and are therefore unaware of what diabetes can do over time. This also goes for high blood pressure. Many people had more than one of these conditions simultaneously.

Malaria and other infections are treated; we do not wait for one’s immune system to attempt to battle a serious illness that might damage one’s organs or result in death; we use vaccination and antibiotics to guard against this possibility whenever possible. We do not typically use mercury for medicine. We are not constantly losing teeth. We are not constantly menaced by tuberculosis and syphilis. Fevers do not rage uncontrolled. Women are not constantly pregnant. Fevers are not blamed on excitement and other issues besides infection. Illness and deaths would not be attributed to sudden shifts in temperature. Complaints of neuralgia seem to arise in every letter. This was probably caused by a variety of conditions, probably infections, but it was clearly a frequent occurrence for people to have severe and seemingly unexplained pain.

Leonard Swett’s wife, Laura, early on in their marriage, contracted “an unspecified polio-like illness that affected her locomotion. Her disability waxed and waned for the rest of her life.”[4] At one point, Swett wrote Lincoln, "She is not yet and never will be a strong healthy woman but as long as she supplies this deficiency by excess of goodness I do not feel like complaining."[5]

“And you are attending to insane people, are you, Mr. Swett,” Mary had told Swett when he finally convinced her to go with him to the courthouse in 1875, “allow me to suggest that you go home and take care of your wife, I have heard some stories on that subject about her.”[6]

Mary’s pointed remark suggests that at least some people—including Mary—believed Laura’s illness to be psychological in nature, or that she had psychological problems in addition to it, the latter of which which would not be at all surprising. Someone bedridden with unpredictable chronic health problems will deal with incredible stress and exhaustion. In 1836—granted, nearly fifty years prior to 1881—Robert E. Lee wrote of his wife, who had been dealing with severe health problems. This included a post-childbirth infection that subjected her to months bedridden in extreme pain as her body fought it off without antibiotics. The doctors also misdiagnosed it. Shortly afterward, she contracted mumps, and Lee reported, “She became extremely affected with fever, which fell upon the brain, and seemed to overthrow her whole nervous system . . . Her nervous system is much shattered. She has almost a horror of crowded places, an indisposition to make the least effort, and yet a restless anxiety which renders her unhappy and dissatisfied.”[7]

Such claims have been treated disparagingly by biographers unable to appreciate such conditions. One scholar wrote of chronic invalid Frances Seward, “In the later years of her life she could be made ill by such simple things as the barking of a dog, the jolting of a carriage, or the glare of gaslights. She complained of a variety of ailments—toothaches, eye trouble, insomnia, pains in her side and legs, chills, fever, and nausea, but the most recurrent complaints were headaches, fever, and neuralgia. In addition, she suffered from prolonged spells of depression. Her disposition became somewhat morbid and she often wrote of her children using such expressions as ‘if she lives’ or ‘if he lives to attain the age of manhood.’”

Such comments reflected the reality of life. While we will never know what she suffered from, some of this comports well with malaria. Teeth problems were by no means exceptional. These symptoms are also somewhat similar to Mary’s.

Childbirth-related injuries were not as easy to repair as they are now. Many women seemed to have ended up with uterine prolapse which may have explained some women’s invalid status. Given that her words suggest whatever gynecological issue she suffered from waxed and waned, Mary may have been one of these women.

The progression of illnesses or diseases had the potential to be so wildly different than now, based on the different ways of diagnosis and treatment, that it is hard to judge. Of course, there were some things well understood and described; but that one doctor (or even observant layman) was so well-informed did not mean others were. Swett’s biographer noted that, “The newspapers of the day either overdiagnosed various maladies or emphasized his recent health. Swett's death certificate, however, showed his cause of death as diabetes mellitus.”[8] Meanwhile, Isaac Arnold’s terminal six-week long illness was reported to be caused by “overexertion of the metnal faculties, and “too constant application” at his literary labors, though he had the best medical care.[9]

The absence of X-ray and MRI technology made dealing with internal injuries far more complicated. How could they figure out exactly what had happened or what was going on?[10] This would seem to have been a particular problem with non-compound fractures and damage to the skull and brain, or other organs. Sometimes it was obvious enough; a compound fracture or a piece of your skull falling out, or a tumor in a woman’s breast. But quite often doctors had to take their best guess. The debate over the nature of Charles Sumner’s injuries illustrates this. Were they physical or caused by post-traumatic stress disorder? The answer could easily be one or both. But the fact remains that X-ray machines did not exist, and the doctors could not have known much about a skull fracture. They would have noticed if a piece of his skull fell out, but not a more minor but significant damage.

Charles Sumner’s doctors treated his head injury symptoms following the famous caning under a theory that involved burning his skin, for which he refused anesthesia, which was thought to lessen the treatments effectiveness. If he didn’t have severe physical and probably psychological problems to begin with, he did after that! He was also terrified of losing his celebrated intellectual ability, which he was advised that any excitement could accomplish.

“My head received the force of the fall & it has brought on constant spasms of neuralgia in the back of the neck and in the left side,” Jesse Benton Fremont wrote after a carriage accident in the 1850s, “often the whole spine thrills like a harp cord.”[11] She later cited it as the source of her cardiac trouble. Similarly, Charles Sumner was advised that his heart condition was linked to a spinal condition which was linked to his head injury. In the final months of Sumner’s life, less than a decade before, he wrote that he was under medical treatment for this, “chiefly through poisons to act on the spinal cord.”[12]

Of course, things had changed—these things were relevant as to Mary’s health in former years, but it was now 1881. Still, Hirschhorn and Feldman noted Sayre’s bizarre claims that He contended that irritation of the genital area could somehow produce ‘inflammation at a distance’ of the spinal cord, a theory he first explored in his graduation thesis form medical school in 1842.”[13]

His thesis did not come out of nowhere. Doctors in the nineteenth century noticed a pattern of symptoms that consistently surfaced among railway accident survivors. Doctors described the condition as “Railway Spine,” and attributed it to spinal injuries that affected the rest of the body, and which affected mental health and wellbeing.[14] In reality, it was a manifestation of post-traumatic stress disorder.[15] (In one of her letters, Mary Lincoln perceptively mentioned that a woman she knew displayed similar symptoms to those of certain soldiers they had referred to as “demoralized.”)

Perhaps most significantly President Garfield was shot in 1881, and despite his status, his medical care was so atrocious that his assassin, who had just been indicted on murder charges, argued he should be acquitted because Garfield was killed by malpractice, not his bullet.[16] And, as they lacked X-rays and MRIs, their difficulties in part stemmed from their inability to locate the bullet, which resulted in incorrect assumptions and treatment. Alexander Graham Bell tried his best with a metal detector. Some doctors, knowing better, did object to the course pursued (the idea of antisepsis had been proposed, but was not widely accepted), but the point is that there was serious disagreement on basic things among prominent doctors.[17]

Attention was initially draw to the possibility of Mary suffering from syphilis due to somewhat cryptic remarks made by Lincoln’s long time law partner, William H. Herndon, who had extensively researched Lincoln’s life, but whose analysis of the evidence sometimes veered into a strange conclusion. His presumed suspicion and insinuation was that Lincoln had transmitted syphilis to his wife. He got on this line of thought because he claimed to know Lincoln himself believed he had contracted syphilis, prior to his marriage. If Lincoln expressed this fear, it would not be all that surprising, as young men were understandably paranoid about it, and sometimes other sexually transmitted infections were mistaken for it. Lincoln was known to have written to a doctor about an unknown health problem around the time the first engagement between him and Mary Todd was broken off.

The most detailed discussion of Mary’s health, including the possibility of syphilis infection, implies that if Mary had it, she was the only member of the Lincoln family who was infected. This seems like a rather hasty dismissal, given the only suggestions of syphilitic infection (and non-marital sexual activity) in Herndon’s vast record apply to Lincoln himself.[18] Of course, one does not have to rely on Herndon’s beliefs to assess the evidence, and the symptoms are the most relevant evidence, not the rumors surrounding their cause. But this theory was bolstered by an insinuation based on an egregious error. Herndon once wrote to the co-author of his Lincoln biography that “You know Mrs. Lincoln is charged with unchastity and the like.” The authors mistakenly assumed this referred to Mary Lincoln—in fact, it referred to Nancy Lincoln—Abraham Lincoln’s mother.

There is virtually no evidence that either one was unfaithful,[19] but such indiscretions are common enough to humanity that such allegations are far from outrageous. “Further evidence against Lincoln infecting his wife,” Hirschhorn and Feldman argue, after noting Lincoln’s own absence of symptoms, “is that none of the Lincoln’s sons showed signs of congenital syphilis.” Tabes dorsalis “occurs on average one or two decades after the initial infection, with a broad range of three to forty seven years.” They believe it started in 1869, and so “We are left with the unhelpful imputation of a primary infection any time in her adult life.”

“Syphilis was remarkably common in the nineteenth century,” they note. Yet, as it long ago ceased to be common, especially in its later stage form, “a singular study published in 1954 informs most of what we know about the natural course of the disease.” Its progression is not linear or uniform—while there are clear patterns, it affects each person differently. In fact, “despite its recognition for centuries as ‘the great imitator,’ neurosyphilis remains a diagnostic challenge because of its wide spectrum of presentations.” This sounds somewhat similar to HIV infections—those who develop AIDs shown a pattern of uncommon serious health problems. However, which health problems they develop, and on what time table, vary significantly. As syphilis presents so differently in each person and over time, and as there were so many competing serious medical conditions common at the time, it would be difficult to identify syphilis, for which there was no diagnostic test at the time.

Perhaps part of this reasoning is that it is consistent with the idea she got it later in life, perhaps after she ceased childbearing, which goes with their claim that Mary Lincoln did not reach the final stage until 1869, when she began to complain of spinal pain. A syphilis infection almost certainly would not account for her generally known mental problems that date back to the 1840s, including supposed hallucinations. Indeed, the authors of the article proposing this theory believe her instability to be irrelevant because mental illness is impossible to define and because she likely suffered from post-traumatic stress disorder by the time her symptoms became prominent in 1875.

They argue, however, that some of her strange claims were based on physical symptoms, namely stabbing nerve pain, caused by neurosyphilis. She did make such claims with some frequency—although, again, it seems everyone was struck by attacks of neuralgia. The explanation offered by the mental instability associated with neurosyphilis, however, is probably the major factor that interested people in the theory. Of course, that does not bear on her actual situation,[20] but with that assumption gone, the alternative they propose and others have proposed, diabetes, seems natural. It may be relevant that 1869 coincides with the beginning of her first pension battle, which was premised on the claim that she was in poor health.[21]

Tad had difficulty speaking, and was possibly developmentally delayed. This is worth noting because of a strange comment made by Herndon towards the end of his life: “I should like to know one thing and that is: what caused the death of these children. I have an opinion which I will never state to anyone. I know a good deal of the Lincoln family and too much of Mrs. Lincoln. I wish I did not know as much of her as I do; she was a tigress."[22] I would like to briefly address this comment, because it should be dealt with.

One conclusion people have drawn is that he believed two or three of the Lincoln children had died of congenital syphilis.[23] Herndon read widely and followed the latest ideas, so perhaps he had come across a medical article that suggested this theory.

Based on my research, I believe that his tongue and possibly his teeth were somewhat abnormal, though not enough to draw widespread comment in the way that his speech did. The description of his speech sounds to me consistent with that of a hearing impaired person, but presumably someone would have noticed this.[24] Orthodontic issues are by no means uncommon and could explain his wearing of an orthodontic device.

However, Scottish tutor Alexander Williamson, who would have reason to know and an interest in the matter, classified Tad as a less-than-enthusiastic student and “tongue-tacked.” According to a dictionary of the Scottish language popular at the time, the term’s only definition which could apply to Tad was “Tongue-tied; applied to those who have an impediment in speech, in consequence of the membrane which attaches the tongue to the palate, coming too far forward.”[25] In another interview, he used “tongue-tied.” That he says he discussed this with Mary and spoke of in non-figurative terms is persuasive. This is further bolstered by the fact that he suggested an operation to correct it. He strongly urged the operation in 1861, and Lincoln agreed, but Mary “imagined that he might possibly bleed to death & would not therefore give her consent,” a not unreasonable concern.

It is possible that, as has been suggested, Tad had a cleft palate, and this is what Williamson was describing. However, one piece of evidence for that theory is that Tad had difficulty eating. I can find no evidence of this. I do know that a government employee wrote his wife about observing Tad, who he thought “acts rather silly and childish.” His impression was no more favorable when he got a closer look: “One day the boy stood close by me cramming his mouth constantly with handfuls of popped corn.”[26] It is my understanding (and experience) that popcorn is one of the most difficult foods to eat, especially if one has any trouble with teeth. There is by no means convincing evidence that Tad’s issues were caused by congenital syphilis, or even what those issues were. Deafness and abnormal teeth are symptoms of congenital syphilis, but they have countless other causes and were fairly common at that time

The other theory is that Herndon believed she had fatally harmed them, perhaps through behavior consistent with Munchausen’s syndrome.[27] In either case, it seems likely that Herndon read something and his mind, perceiving that it was consistent with some known facts, ran wild with anxious speculation, which seems to have been a common occurrence for him. It would be quite odd to reason forward from the deaths themselves, as the child mortality itself was hardly suspicious. This is an important point to grasp--while, nowadays, losing three children may raise some eyebrows, this was truly not remarkable at the time. There are so many contenders for viral and bacterial infections[28] that in 1860, Elizabeth Edwards wrote to her daughter Julia, who had just lost an infant daughter. “Like yourself, I am constantly fearful, that little Lewis, may be claimed too. How terrible to feel that our children, are only a loan. The diseases of infancy, particularly keep us in constant apprehension.” Her point is made tangible by the fact that while she says she wept bitterly over the news, she more or less moves on in her correspondence past the fact that her six month old granddaughter and namesake (Elizabeth Edwards Baker) had died on January 1. She focuses on Lewis, as that was what parents did to survive—they turned their affections to another child, and prayed that in doing so they hadn’t risked another heartbreak. The child’s gravestone was inscribed “The Loan Returned.” That is all you need to know about infant mortality.