Abraham Lincoln used "Blue Mass" (Mercury Tablets) to treat some of his health issues.

It is well known that Abraham Lincoln used Blue Mass[1] also known as Blue Pills (Mercury Tablets) regularly, but there is debate over what ailment the medicine was intended to address. Historians most commonly state that Lincoln used Blue Mass in the treatment of constipation.

Some historians believe that Lincoln's flashes of temper may have been symptoms of mercury poisoning, brought on by Blue Mass, also a common remedy for "melancholy" depression. It may have been both, as it was commonly believed during the time period that problems of digestion, the failure of the liver to properly secrete bile, could lead to mental disorders. In addition to outbursts of rage, the mercury Lincoln ingested may have caused insomnia, forgetfulness, and possibly hand tremors.

Lincoln's use of Blue Mass may have altered his behavior and may explain the erratic behavior and violent rages to which he was subject over a period of years before the Civil War (April 12, 1861 - April 9, 1865).

One story of Lincoln's angry outbursts claims that during one of the famous 1858 Senate debates between Lincoln and Stephen Douglas, in response to an accusation by Douglas about Lincoln's record in Congress, Lincoln furiously grabbed the collar of a former congressional colleague who, Lincoln said, knew the charge was false, shook the man violently "until his teeth chattered."

Some historians believe that this explains the contrast between his earlier behavior (while he was perhaps suffering from mercury poisoning from his use of Blue Mass) and his later behavior during the war (after he had stopped taking Blue Mass), given that most of the effects of mercury poisoning are reversible. Lincoln took the pills which were as widely used in the 18th and 19th centuries as Prozac is today.

Dr. Marshall Baldwin's Nervous Pills contained an undisclosed
amount of mercury leading to heavy metal poisoning.

Blue Mass was prescribed for anything they thought was related to the liver. But that was based on a faulty theory. It only poisoned you.

Blue Mass (aka; Blue Pills) or as a liquid syrup was sold from horse-drawn wagons, such as this one, all over the country. Each vendor mixed their own formula so the amount of mercury was unknown.

Lincoln's health has been more scrutinized in recent decades, as some scientists have sought to show that he inherited a genetic ailment called Marfan Syndrome, which can lead to a gaunt frame, slender fingers, and internal bleeding. Today geneticists consider this diagnosis unlikely.

A study in July of 2001 gives a new perspective on a president revered for his calm and focused leadership through the historic crisis of the Civil War. That steady temperament appears to have emerged only after Lincoln claimed to have stopped taking the pills that his law partner William H. Herndon said was Blue Mass.

There is, however, evidence that Lincoln continued to take Blue Mass. An interview given by his wife Mary Todd Lincoln, to a correspondent from the Pittsburgh Chronicle suggests that Lincoln continued his use of the medication, despite his earlier statements to the contrary.

In an interview, Mrs. Lincoln described an instance in which her husband's "usual medicine," the mercury-based "blue pills," made him terribly ill. Mrs. Lincoln recalled the fact that her husband had been very ill, for several days, from the effects of a dose of blue pills taken shortly before his second inauguration. She said he was not well, and appearing to require his usual medicine, blue pills, she sent to the drug store and gave him a dose that night before going to bed, and that next morning his pale appearance terrified her. "His face," said she, pointing to the bed beside which she sat, "was white as that pillow-case, as it lay just there," she exclaimed, laying her hand on the pillow—"white, and such a deadly white; as he tried to rise he sank back again quite overcome!" She described his anxiety to be up, there was so much to do, and her persistence and his oppressive fatigue in keeping him in bed for several days. They both thought it was so strange that the pills should affect him in that way, as they never had done so before. They both concluded that they would not get more medicine from that pharmacy, as the attendant evidently did not understand how to make up prescriptions.

NOTE: Abraham Lincoln had Malaria,[2] 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 ones lifetime.

RUMOR: 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, because his personal valet, William H. Johnson, develop smallpox caring for Lincoln after the Gettysburg address and he died from it.

Unfortunately, since no hair samples from Lincoln during this period are available, it is impossible to determine whether or not he was truly suffering from mercury poisoning while he was taking Blue Mass.

Did Lincoln's Blue Mass Pills Cause Uncontroable Anger?

Abraham Lincoln reached over and picked a man up by the coat collar at the back of the neck and shook him "until his teeth chattered." He became so angry "his voice thrilled and his whole frame shook." Lincoln only stopped when someone, "fearing that he would shake Ficklin's head off," broke his grip. A new study suggests that mercury poisoning may explain Lincoln's bizarre behavior. 

Lincoln during in this 1858 Lincoln-Douglas debate is a far cry from our vision of Lincoln at the Lincoln Memorial, sitting patient and thoughtful with the weight of the nation on his shoulders. A study published in the Summer of 2001, issue of Perspectives in Biology and Medicine reformulates a common anti-depressive medication of the nineteenth century and shows that it would have delivered a daily dose of mercury exceeding the current Environmental Protection Agency safety standard by nearly 9000 times.

"We wondered how a man could be described as having the patience of a saint in his fifties when only a few years earlier he was subject to outbursts of rage and bizarre behavior," said Norbert Hirschhorn, M.D., retired public health physician, medical historian and lead author of the study. 

"Mercury poisoning certainly could explain Lincoln's known neurological symptoms: insomnia, tremor, and the rage attacks," said Robert G. Feldman, M.D., professor of neurology, pharmacology, and environmental health at the Boston University Schools of Medicine and Public Health, an expert on heavy metal poisoning and co-author of the paper. "But what is even more important, because the behavioral effects of mercury poisoning may be reversible, it also explains the composure for which he was famous during his tenure as president."

Lincoln was known to have taken "blue mass," a pill containing mercury, apparently to treat his persistent "melancholia," (then known also as hypochondriasis.) In 1861, a few months after the inauguration, however, perceptively noting that blue mass made him "cross," Lincoln stopped taking the medication. 

"We wanted to determine how toxic the mercury in the blue mass pills was likely to be," said Ian A Greaves, M.D., associate professor of environment and occupational health and associate dean at the University of Minnesota School of Public Health, coauthor. "We used a nineteenth-century recipe to recreate blue mass. The ingredients included, besides mercury, licorice root, rose-water, honey and sugar, and dead rose petals. It was compounded with an old-fashioned mortar and pestle and rolled to size on a 19th-century pill tile. But, in accord with 20th-century safety standards, we wore surgical gowns, gloves, masks, and caps and worked with modern ventilation equipment."

Caution was well advised. The method of compounding the blue mass pill, dispersing the mercury into fine particles and increasing its surface area, was meant to assure its absorption into the body and did. The vapor released by the two pills in the stomach would have been 40 times the safe limit set by the U.S. National Institute for Occupational Health. The solid element of mercury absorbed from two pills would have been 750micrograms. The EPA indicates that only up to 21micrograms of any form of mercury per day may safely be ingested. Someone who ate the common dose of two to three little pills per day would have seriously risked poisoning. 

"The wartime Lincoln is remembered for his self-control in the face of provocation, his composure in the face of adversity," said Hirschhorn. "If Lincoln hadn't recognized that the little blue pill he took made him 'cross,' and stopped the medication, his steady hand at the helm through the Civil War might have been considerably less steady." 

Compiled by Neil Gale, Ph.D. 

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[1] Blue mass was used as a specific treatment for syphilis from at least the late 17th century to the early 18th. Blue mass was recommended as a remedy for such widely varied complaints as tuberculosis, constipation, toothache, parasitic infestations, and the pains of childbirth.

A combination of blue mass, and a mixture called the common black draught, was a standard cure for constipation in early 19th century England and elsewhere. It was particularly valued on ships of the Royal Navy, where sailors and officers were constrained to eat rock-hard salted beef and pork, old stale biscuits (hardtack), and very little fruit, fiber, or other fresh food once they were at sea for an extended period.

It was a magistral preparation, compounded by pharmacists themselves based on their own recipes or on one of several widespread recipes. It was sold in the form of blue or gray pills or syrup. Its name probably derives from the use of blue dye or blue chalk (used as a buffer) in some formulations.

The ingredients of blue mass varied, as each pharmacist prepared it himself, but they all included mercury in elemental or compound form (often as mercury chloride, also known as calomel). One recipe of the period included (for blue mass syrup):

33% mercury (nearly one-third, measured by weight) 5% licorice25% Althaea (possibly hollyhock or marshmallow)3% glycerol34% rose honeyBlue pills were produced by substituting milk sugar and rose oil for the glycerol and rose honey. Pills contained one grain (64.8 milligrams) of mercury.

Mercury is known today to be toxic, and ingestion of mercury leads to mercury poisoning, a form of heavy metal poisoning. While mercury is still used in compound form in some types of medicines and for other purposes, blue mass contained excessive amounts of the metal: a typical daily dose of two or three blue mass pills represented ingestion of more than one hundred times the daily limits set by the Environmental Protection Agency in the United States today.

[2] 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 (a fever or shivering fit), 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, 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 a number of 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 musquitoes the next night with smoke. He did so, and after that, I was not troubled so much with them. 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, something similar to what the Yankees would call a brook. I was very much disappointed in the appearance of the country when I arrived there, for I anticipated finding something great, and did not know but that I might on the River Raisin find the article growing on trees! 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 the county of 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 round in the neighborhood for some time, and at last, was taken with a violent chill and fever, and had to take my bed 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 doctor-stuff the old doctor had, pretty much, he told me that it was a very stubborn case, 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 me for some time. I still kept getting worse and became so delirious as not to know 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 that I would surely die if I did not follow the directions of the doctor. 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 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 that my intention was to take my horse and wagon and try to get to St. Louis; for I did not think that I could live long in that country, and 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 at last arrived at St. Louis, very feeble and weak, and did not care much how the world went at that time. 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 which we traveled the last 200 miles, more than one half the people are sick; this I know for I have seen it. We called at almost every house, as they are not very near together, but still, 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.