Sunday, November 18, 2018

Lincoln Came Near Death from Smallpox while giving the Gettysburg Address.

On the train to Gettysburg, Pennsylvania, Lincoln began to tell his staff that he was feeling weak, but he finished editing his address and continued on to Gettysburg. When they arrived, Lincoln rode to the cemetery on horseback and viewed the area and plans. 

When the program began on November 19, 1863, Lincoln sat on the platform for over two hours while classical scholar Edward Everett spoke and during the music piece Dirge by Composer Alfred Delaney.
Dirge was sung at the consecration of the Soldier's Cemetery
at Gettysburg, Pennsylvania, on November 19, 1863.
Composed and Arranged for Four Voices. 

Lincoln was feeling weaker all the while, and observers called his color "ghastly." When the President finally got up, he stunned the crowd with his short address (271 words in ten sentences in just over two minutes); most were unaware they missed it. 

Lincoln judged the crowd's silence as disappointment and left Gettysburg himself disappointed. On the train back to Washington, Lincoln grew feverish and weaker still. His valet, William Henry Johnson, sat up with the President, wiping his face with a wet cloth to cool him.
Painting of Abraham Lincoln giving the Gettysburg Address.
By the time Lincoln returned to Washington, his weakness had progressed, and he had become feverish with severe headaches and back pain. By the fourth day of symptoms, a red rash appeared that developed into scattered blisters by the next day. A good description of the rash and its development is lacking. The president's personal physician, Dr. Robert King Stone, first diagnosed him with a cold, then "bilious fever" (fever associated with excessive bile), and then scarlatina (scarlet fever). Both scarlet fever and malaria[1] were common in early 19th century America, including Lincoln's home state of Illinois.
A rare photo of the Gettysburg ceremonies. A group of boys stands at the fringe of a crowd. In the distance, several men wearing sashes can be seen standing on the speakers' platform. Analysis of an enlargement of this photo reveals the image of Lincoln sitting to the left of these men.
Goldman and Schmalsteig reviewed Dr. Stone's records; oddly, he apparently never mentions this illness, though he attended the President through the entire period. As the rash progressed, Dr. Washington Chew Van Bibber was called in for a consultation. After examining the President, he diagnosed a mild case[2] of smallpox (varioloid). Much later, Dr. Van Bibber's version of a conversation with the President was recorded in the autobiography of another surgeon:

Abraham Lincoln photographed
by Alexander Gardner on
November 8, 1863, 11 days
before the Gettysburg Address
"Mr. President, if I were to give a name to your malady, I should say that you have a touch of varioloid" [the old-fashioned name for smallpox]. "Then am I to understand that I have smallpox?" Lincoln asked, to which the Doctor assented. "How interesting," said Mr. Lincoln. "I find that an unpleasant situation in life may have certain compensation every now and then. Did you pass through the waiting room when you came in just now?" He replied, "I passed through a room full of people." 'Yes, that's the waiting room, and it's always full of people. Do you have any idea what they are there for?" "Well," said the Doctor, "perhaps I could guess." "Yes," said Mr. Lincoln, 'they are there, every mother's son of them, for one purpose, namely, to get something from me. For once in my life as President, I find myself in a position to give everybody something!"

By day 10 of symptoms, the fever was decreasing, and the rash began to itch and peel. The weakness persists the longest, preventing him from returning to work for the official business for 25 days. Visitors report that he was beginning to walk briefly by December 7 (day 19 of symptoms) and that marks of the rash were visible, but few, if any, remained as facial scars. On December 15, he could work for a few hours and went to a play at Ford's Theater. A month later, on January 12, he was reported as having regained most of his old vigor, though still underweight.

Abraham Lincoln had malaria at least twice. The first time was in 1830 (21 years old), along with the rest of his family. They had just arrived in Illinois that year. The second episode was in the summer of 1835 (26 years old) while living in New Salem, Illinois. Lincoln was then so ill he was sent to a neighbor's house to be medicated and cared for. Malaria, during that time period, would often rear its ugly head throughout one's lifetime.

RUMOR: "Abraham Lincoln Had Marfan Syndrome." Today, geneticists consider the diagnosis unlikely.

UNFOUNDED: Lincoln's son, Willie, died from typhoid fever. It is only speculation that Lincoln suffered from typhoid fever at the Gettysburg address. But it is more likely that Lincoln had a mild case of smallpox, as his valet William Henry Johnson developed smallpox caring for Lincoln after the Gettysburg address, and he died of it on January 28, 1864.

Compiled by Dr. Neil Gale, Ph.D.

[1] Malaria was a common disease in Chicagoland and southern Illinois in pioneer days, wherever swamps, ponds, and wet bottomlands allowed mosquitoes to thrive; the illness was called ague, or bilious fever, when liver function became impaired; medical historians believe that the disease came from Europe with early explorers around 1500; early travel accounts and letters from the Midwest reports of the ague (a fever or shivering fit), such as those of Jerry Church and Roland Tinkham, the details of which are extracted from their writings:

From the Journal of Jerry Church, when he had "A Touch of the Ague" in 1830: ...and the next place we came to of any importance was the River Raisin, in the state of Michigan. There, we met with several gentlemen from different parts of the world, speculators in land and town lots and cities, all made out on paper, and prices set at one and two hundred dollars per lot, right in the woods, and musquitoes and gallinippers thick enough to darken the sun. I recollect the first time I slept at the hotel, I told the landlord the next morning I could not stay in that room again unless he could furnish a boy to fight the flies, for I was tired out myself and not only that, but I had lost at least half a pint of blood. The landlord said that he would remove the mosquitoes the next night with smoke. He did so, and I was not troubled so much with them after that. We stayed there a few days, but they held the property so high that we did not purchase any. The River Raisin is a small stream of water, similar to what the Yankees call a brook. I was very disappointed in the country's appearance when I arrived there, for I anticipated finding something great and did not know that I might see the article growing on trees on the River Raisin! But it was all a mistake, for it was rather a poor section of the country. ...We then passed on to Chicago, and there I left my fair lady traveler and her brother and steered my course for Ottawa in Lasalle, Illinois. Arrived there, I put up at the widow Pembrook's, near the town, and intended to make her house my home for some time.

I kept trading around in the neighborhood for some time and was taken with a violent chill and fever and had to lay down at the widow's, send for a doctor, and commence taking medicine, but it all did not do me much good. I kept getting weaker every day, and after I had eaten up all the doctors-stuff the old Doctor had, he told me that it was a very stubborn case, and he did not know he could remove it, and he did not know as he could remove it, and thought it best to have counsel. So I sent for another doctor, and they both attended to me for some time. I kept getting worse and became so delirious as not knowing anything for fifteen hours. I, at last, came to and felt relieved. After that, I began to feel better and concluded that I would not take any more medicine of any kind, and I told my landlady what I had resolved. She said I would surely die if I did not follow the Doctor's directions. I told her that I could not help it, that all they would have to do was to bury me, for my mind was made up. In a few days, I began to gain strength, and in a short time, I got so that I could do a walkabout. I then concluded that the quicker I could get out of those "Diggins," the better it would be for me. So I told my landlady I intended to take my horse and wagon and get to St. Louis, for I did not think I could live long in that country. I concluded I must go further south. I accordingly had my trunk re-packed and made a move. I did not travel far in a day but finally arrived at St. Louis. I was feeble and weak and did not care much about how the world went then. However, I thought I had better try and live as long as there was any chance. 

From a letter by Roland Tinkham, a relative of Gurdon. S. Hubbard, describing his observations of malaria during a trip to Chicago in the summer of 1831: ...the fact cannot be controverted that on the streams and wet places, the water and air are unwholesome, and the people are sickly. In the villages and thickly settled places, it is not so bad, but it is a fact that in the country in which we traveled the last 200 miles, more than one-half of the people are sick; this is what I know for I have seen. We called at almost every house, as they are not very close together, but there is no doubt that this is an uncommonly sickly season. The sickness is not often fatal; ague and fever, chill and fever, as they term it, and in some cases, bilious fever are the prevailing diseases. 

[2] Did Lincoln have a full-blown case, or was it mild due to a previous smallpox vaccination (or variolization)? Modern vaccination protocol uses the related vaccinia virus (cowpox) to elicit immunity to protect against smallpox.

Variolization takes material from an active smallpox lesion and inoculates a healthy person through a cut in the skin. Variolization is riskier than vaccination because it can produce a full-blown case of smallpox. Yet, smallpox was so devastating, with such a high mortality rate (about 30%), that people were willing to undergo variolization, and the mild case of smallpox it usually created to increase their chances of surviving smallpox.

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