Tuesday, November 10, 2020

Abraham Lincoln’s Boyhood Skull Fracture and Brain Injury from Being Kicked in his Head by a Horse.

The physical constitution of Abraham Lincoln has perplexed his biographers and portrait sculptors and painters, as it did his personal friends, because of certain enigmatical qualities in his face and personality. More books, articles, and speeches are said to be presented yearly on Lincoln than on any man in history, and his philosophy of democratic government of the people, by the people, and for the people has become the philosophy of the democratic political organization of the United Nations, as well as the United States. It is therefore important that any new evidence on his physical constitution and neuroses that would be helpful in understanding his personality should be published.

The following discussion presents a new consideration of the evidence on his genetic and endocrine constitution, followed by a new, recently discovered evidence of an accidental fracture of his skull in childhood from the kick of a horse. This fracture left certain permanent injuries and functional impairments of his brain that greatly influenced the schizoid, melancholic-euphoric development of his personality and thereby his marital life and legal and political career.

Lincoln's face gave evidence of unusual hereditary (transmitted or transmittable from parent to offspring) genetic predispositions in its embryonic development, and hence in the development of his brain and personality. The creases in the skin of the human face are produced principally by the activities of the muscles of the face with attachments to the skin. In most faces, the crease that runs on either side from the nose continues below the cheek and around the upper lip and corner of the mouth and then passes more or less distinctly around and under the lower lip. In Lincoln's face, as shown by his life mask and photographs, these creases, one on each side, pass from the nose part way only around the upper lip and then turn sharply backward well above the corners of the mouth. Here they join unusually deep creases that run downward from in front of the cheekbones, between the buccinator muscle of the cheek and the masseter muscle of the jaw, and then curve forward well back of the mouth, to pass under the chin, where they meet. The expressive effect of this unusual, though not rare, type of facial creasing was enhanced by the length and narrowness of his face. This type of facial creasing is characteristic of the great apes, and when it exists in man it indicates a primitive type of hereditary nervous differentiation.

Three genetic moles, one on the right side and two on the left side of the face, gave, in relation to these creases, a distinguishing quality to Lincoln's face, which, once seen, was not likely to be forgotten and was, therefore, socially and politically invaluable. The largest and most prominent mole was located on the right side of his face, just above the crease as it turned back from the upper lip to join the crease lying between the muscles of mastication and the mouth. The mole actually divided the crease, producing a perpetually dimpled, smiling effect on that side of the face. On the left side of the face, one of the other two moles lay on the cheek above the crease where it turned back from the upper lip, and the other lay lower down on the side of the face, back of the crease, after it joined the masticator-buccinator crease. The positions of these moles in relation to the mole on the right cheek indicate that early in embryonic development when the head was very small and the face was beginning to form, the right and left moles appeared in symmetrically opposite positions. If this is true, the mole on the left cheek later became divided, and the two parts separated progressively as the muscles and bones of the face enlarged.

Although the psychological effect of these unusual facial characteristics is now unknowable, they gave his face a ready-to-smile set and an unusually comical quality that surely must have reinforced the development of his great sense of humor and propensity to laughter. They probably also combined with other unusual inherited and acquired facial and bodily qualities in reinforcing the formation in his boyhood of the conviction that he was an unusual person, predestined to perform some great mission to be revealed to him, a conviction which developed later into his unique, fixed, lifelong humanitarian inspiration and compulsion.
As an adult, his hair was coarse and black, and his eyes were small, deeply set, and described as gray by those who knew him personally, including his wife and his niece.. His ears were large and thick-lobed and extended almost at right angles to his head. His usually long and generally disheveled hair hid this grotesque, comical, inferior feature. His nose was not actually oversized, but it looked large because of his long, thin face. The nostrils did not extend as far into the tip of the nose as in most people so that the end looked heavy. Lincoln was thought, when young, to be somewhat sensitive about his nose, but not about his ears. He was sometimes ridiculed for being "horse-faced."

Lincoln's body growth and energic constitution show gross evidence of pituitary hyperactivity and gonadal hypoactivity. He was a long, thin baby at birth, with unusually long, thin arms and legs. His body was morphologically like that of his tall, thin mother. She was said by her cousins John Hanks and Dennis Hanks to have been "5 feet 8 inches high" and to have weighed about 130 lb., whereas his father was 5 ft. 10 in. tall and weighed about 190 lb. Lincoln grew to 6 ft. 4 in. in height and generally weighed less than 180 lb. His legs and arms were disproportionately long for his body, which, when seated, was about the length of an average six-footer.

The skin of his face was weather-beaten, coarse, deeply grained, dark, and generally sallow or muddy. Many years of close exposure in youth before an open wood fire where he read, possibly left a permanent trophic effect. Deep creases over the forehead, at the outside corners of the eyes, and around the mouth indicate an unusual amount of facial work in using the eyes and in laughing.

The neuromuscular tonus of his body was more relaxed than that of the average man. This was shown in the slow, drawling, staccato monotone of his speech; the deliberate, contemplative, meditative manner and slow mental reaction time, and the flat feet. He seems also to have had a lower blood pressure than normal, which probably, when too low, contributed to the production of nervous depression. Self-conscious of his height, he tended to slouch, with stooping of the shoulders and slight bending at the knees; but he generally held his chin up, his posture indicating an ego attitude of humility counterbalanced with well-determined self-reliance and self-respect.

Dr. K.C. Wold has also reviewed the evidence on Lincoln's physical constitution in relation to his health. He has concluded that any endocrinopathy was limited to indications of thyroid dysfunction, and possibly a slight postpubertal overactivity of the pituitary, which might account for his disproportionately long legs and arms for the rest of the body. Attempts to explain Lincoln's melancholic disposition on an endocrinologic basis would be, Dr. K.C. Wold, says rightly, "merely a venture in the realm of fancy."

However, even though his endocrine constitution is not fully known, it would be more erroneous to disregard the indications of some degree of the pituitary, thyroid, and gonadal endocrinopathy than not to consider these factors as having possibly contributed to his hypokinetic constitution.

Many years of hard farm work and wood chopping from childhood to adulthood, out of dire necessity for living, gave him an unusually large and powerful muscular development of the hands and arms, back, and shoulders. His neck, though strong, was long and scrawny in relation to his head and sloping shoulders. His lower jaw was long and heavy and inclined to the acromegalic form.

His constitutional morphologic type was predominantly Kretschmerian asthenic or Sheldonian ectomorphic and cerebrotonic, and his energic constitution was Kempfian hypokinetic. These qualities indicate that Lincoln was probably somewhat hyperpituitary (abnormal condition of the pituitary gland) and hypogonadal (a problem with the signals from the brain to the testicles) in the endocrine (glands which secrete hormones directly into the blood) ratio. His constitution disposed to some reduction of autonomic pressure of energy in sexual directions and tended to produce shyness with women and a preference for the company of men, factors of endlessly contributory and determinative influence on the social conditioning and development of his personality.

His slow, drawling speech, slow reaction time, mental deliberateness, and pedestrian rhythm in his style of speaking and writing was so consistent with his energic constitution and morphologic type that the latter, obviously, largely determined the former. In Lincoln, the physio psychological cyclical sequence dominated the psychophysiological cyclical sequence of reactions. In other words, he must be, and generally was, guided by his feelings in what he said and did, for if they did not support him in the work of fulfilling certain self-commitments he would become miserable, if not melancholic.

If we examine the full-face photographs of Lincoln and the Volk life mask (1860) of his shaven face, we see that the forehead is narrow and high and bulges slightly in the midline. There is an unusual depression in the forehead of the mask, with a palpable edge, near the midline above the left eye. This deformation indicates the place of fracture of his skull. His head was said by some of his schoolmates, over 50 years later, to have looked small to them (probably relative to his height). Measurement of the Volk life mask between the bases of the tragi of the ears shows a breadth of 6 inches, which is somewhat greater than the breadth of the average head. Hence biographical statements that his head was small are erroneous (see Volk's 1860 Life Mask). 
Abraham Lincoln Life Mask (Volk),1860.
In his photographs and masks, the left eye is set higher than the right. His left eyebrow is usually elevated more than the right, to help in keeping the upper lid retracted and the pupil of tile left eye exposed. The tendency of the left eye to turn upward left uncovered more of the white surface of the sclera below the iris, giving a slightly staring effect of that side, in strange disharmony with the appearance of the right eye. In the best frontal photograph (below) the left eye is definitely out of focus and turned reflexly slightly upward and possibly outward. This deviation is due to the weakening of certain extraocular muscles - possibly the inferior rectus, which is innervated by the third cranial nerve, and/or the superior oblique, which is innervated by the fourth cranial nerve. Lincoln's right eye was used dominantly for general vision and no doubt entirely for reading.
Lincoln after the Battle of Gettysburg, Alexander Gardner, November 8, 1863.
Further examination of the face shows that the left half of the upper lip is somewhat thicker than the right half and less expressive, which is less unvolitionally and volitionally active. Also, the right half of the lower lip protrudes more markedly than the left and is pulled toward the right by the muscles of the cheek. This action characteristically holds the lower lip and facial muscles slightly toward the right. The right side of the chin is also slightly larger than the left, indicating stronger muscle tonus and development from more active use. The right nasofacial crease, previously described, runs somewhat farther from the midline than the left, and the tip of the nose crooks significantly toward the right. These muscles are supplied by the seventh, or facial, nerve. Although his larynx was large, he had a rasping, high-pitched voice, which grew shrill and squeaky upon emotional excitement, indicating some increase in muscle tonus of the vocal cords or the pharyngeal muscles, under control of the 10th cranial (vagus) nucleus.

This deformation becomes distinctly visible when the full-face photograph is turned upside down. When the Volk mask is turned upside down, the larger size of the face, the greater prominence of its lip, chin, and lower jaw, and the greater depression of the face under the cheekbone on the right side are striking.
All these differences in the development of the facial muscles and bones, and the weakened functioning of the ocular and facial muscles on the left side, in particular, indicate that Lincoln suffered a serious injury to his brain before adulthood. The sharp depression in the forehead above the left eye with a definitely palpable edge in the first Lincoln life mask, previously described, shows where his skull had been fractured, and the permanent differences in the nervous tone of the muscles of the two sides indicate that his brain was then permanently injured.
Leonard Volk completed Lincoln's First Life Mask in Chicago, Illinois, in April of 1860.
With this conclusion in mind, Search the history of Lincoln’s childhood for evidence of such an accident and found that it occurred in 1819 at 10 years old at Little Pigeon Creek, Spencer County, Indiana. He was driving an unshod horse (a horse not wearing shoes) hitched in a circular mill for grinding grains or sugar cane, and growing impatient of her slow pace he shouted, "Get up, you hussy," and gave her a whack with a stick on her rump. She kicked back, hitting him on the left side of his forehead. He was knocked unconscious for many hours and was thought for a time to be dead. He seems to have recovered without apparent serious after-effects since he received no special medical attention for the head injury from the doctor living many miles away. Fracture of the skull and cerebral after-effects were never suspected, or at least never reported, by any of his physicians, although after the age of 30 he consulted several for treatment of melancholia (persistent depression) and other nervous symptoms. This omission is not surprising, for it was not until after 1890, upon application of x-ray photography, that neurophysiology learned how to explain some of the cerebral effects and nervous consequence of fractures of the skull.

Ample recording methods now show that an appalling amount of damage to the brain follows blows on the head, at the point of impact and from hydrostatic repercussion (the equilibrium of brain fluid and the pressure exerted at rest, occurring sometime after the event) 'contrecoup' (a contusion resulting from the brain contacting the skull on the side opposite from where the impact occurs), through the production of petechia (a minute reddish spot containing blood that appears in the skin or mucous membrane as a result of localized internal hemorrhages), as well as larger subdural blood clots, without external evidence of fracture. Blows on the forehead in boxing have been found to bruise by concussion the frontal lobes of the brain, sometimes with permanent, stupefying, "punch-drunk" effects, without visible injury on the outside of the head.

Although modern neurology requires for diagnosis a far more complete examination of the living subject for positive or negative evidence of nervous impairment, a tentative consideration of several types of injury to the brain that might have produced the unusual complex of symptoms in Lincoln's case, as far as is known, is desirable.

The blow on the forehead over the left eye evidently fractured the skull at the point of impact. The size and depth of the depression are evidence of its severity. It is most likely that a subdural hematoma of considerable size and petechial hemorrhages developed. The left frontal lobe was certainly damaged, which, in a right-handed, right-eyed person, would possibly have some modifying after-effects on the personality.

The evident, permanent weakness of conjugate movements of the left eye, with the tendency of the eye to turn slightly upward and outward, and the weakness in the tonus of the left facial muscles constitute a symptom complex that cannot be satisfactorily explained by a single area of permanent injury to the brain. The lifelong hypertension of the muscles of the pharynx (the membrane-lined cavity behind the nose and mouth, connecting them to the esophagus) and/or larynx (the hollow muscular organ forming an air passage to the lungs and holding the vocal cords) is also indicative of the involvement of autonomic nervous action, as are his daily repetitive moodiness and emotional instability.

Hydrostatic repercussion within the skull on the opposite side (contrecoup) might have damaged, by shock or limited subdural hemorrhage, the right cerebral cortex in the lower frontoparietal area, where the weakened muscles have motor representation close together in a small area. But since the facial muscles have bilateral cortical (outer layer of the cerebrum) representation, the effects of such an injury in a boy would have been completely compensated for within a few weeks; hence permanent damage must have occurred in some other area.

Such weakening of the left facial muscles would probably have only minor secondary effects on the personality.

The production of a high-pitched, rasping voice was more important, but Lincoln largely overcame this professional deficiency by speaking thoughtfully, slowly, and clearly, always with the common-sense intention of expressing himself directly in the simplest words and thoughts that fitted the subject.

Decoordination of the left eye was more serious in that it tended to produce diplopia [1] and severe eyestrain, which was increased upon fatigue or emotional excitement, with the sequelae of headache, nausea, indigestion, and depression. The deformation of facial expression and stress of diplopia required the development of the mental counter defenses and compensations, which characterized his personality.

Lincoln had other symptoms of permanent nervous lesions. With his rasping, high-pitched, nervous voice, he spoke in a slow, staccato monotone, indicating a deficiency in sense of inflection in a public speaker, who naturally would have greatly desired this ability.

But most significant of all the symptoms was the repetitive tendency to lapse automatically into a lower conscious state, of mental detachment or abstraction, with characteristic facial expression, described by some of his friends as "ugly and stupid-looking," and by others as "dull," or "sad and abstract." or "detached," or "withdrawn." He told his friends, when a man in the 40’s, that he was never without "melancholy." Upon being stimulated by his environment in a way that aroused autonomic-affective reactions of interest, as by some incident or some person's talk, or by reading, his facial expression was observed to change quickly from dull indifference to animated interest, with the tendency to smile and laugh. William Herndon, his law partner, said he would sometimes burst out laughing to himself without apparent cause.

Several men and women friends (Mary Owens, W. H. Herndon, L. Swett, and Mrs. Lincoln) saw in him an unusual lack of appreciation of beauty, nicety, and refinement, and an inordinate fondness for laughing over vulgar, witty stories with clever, practical, or moral application. In contrast to this kind of aesthetic lapse, he was extremely fond of certain beautiful qualities of prose and poetry and memorized many passages from the Hebrew Bible, Shakespeare, Burns, Gray, Goldsmith, and other poets. Most of all, he was highly conscientious about being truthful, reliable, honest, kind, fair, just, and loyal. His sense of fitness in the clarity, and logic of his statements, his discrimination of innocence and guilt, truth and deception and justice in the courtroom, and his sense of definition and appropriateness in his speeches, was masterly. These aesthetic contrasts, of deficiency in some respects and of supremacy in others, might have been the effects of cultural preference more than of cerebral capacity.

The continuous tendency to lapse into melancholy or gloomy "blues" was, however, probably consistent with a permanent, cerebrally initiated, schizoid tendency to lapse automatically into a mentally dull, detached, drowsy state, and then to react, upon interpersonal stimulation, with excessive euphoric compensations.

This inhibitory-reaction tendency was also relatively overcome by the culture of certain forms of self-excitation, such as reading aloud to himself or other people, telling humorous stories, and becoming particularly adept in engaging in legal fights for justice. He liked to read aloud, he said to Herndon, for thereby he gained the benefit of hearing, as well as seeing, what he read and remembered it more easily.

Two different loci of cerebral injury might have produced the complex volitional mental instabilities with the unstable sympathetic nervous reactions under stress or fatigue. One such locus would be a subcortical disruption (thalamic-sensory or hypothalamic-motor) at the head of the autonomic nervous system that depressed sympathetic nervous action and tended to produce dullness or drowsiness upon lack of excitatory stimulation. The other would be an impairment of the frontal cortex on the left side (of a right-eyed and right-handed person), involving the corticothalamic cycle of nerve impulses, that reduced the volitional production of the conscious stream of visual imagery of self-in-its-environment so that such a person would require more external stimulation than would a normal one in order to remain mentally attentive. A person with this type of cerebral lesion, in order to keep mentally alert, would have to be involved or keep himself involved, in emotionally stimulating situations by cultivating special stimulating interests and objectives, such as a passion for legal justice for all people. Lincoln did just this, as a humorist seeking happiness and as a humanist seeking justice, in an endless fight to overcome the tendency to lapse into a rut of sad, gloomy, suicidal preoccupations.

The earliest evidence of Lincoln's diplopia and astigmatism [2] visual discoordination had been recorded by Dr. Thomas Wesley Shastid (1831-1912), as told to him by his father, John Greene Shastid (1798-1874).

When John Shastid lived in New Salem, Illinois, and knew Abe Lincoln, then in his mid-twenties, as the storekeeper and postmaster of the town. 
The Berry-Lincoln Store was probably the first building in the original village of New Salem, constructed in 1829. The building was sold to William F. Berry and Abraham Lincoln as a General Store in January of 1833. This venture didn't last long. According to Lincoln, the business simply put him deeper and deeper in debt. In April of 1833, he sold his interest in the store to Berry. The conscientious manner in which Lincoln worked as a store clerk and his everyday dealings with people led to Lincoln's nickname of “Honest Abe.”
John Shastid described him as a melancholy but kindly spoken person, who liked to amuse children, as well as grown-ups. Abe would sit on a box in front of the store when not waiting on a customer, generally with a dejected and abstracted expression. He would sometimes lie on the ground near the store, with his bare feet elevated against the trunk of a tree, and read. John noticed that Lincoln's left eye looked queer at times and would suddenly cross and turn upward. 
The John Shastid House (rearview) is located at 326 East Jefferson Street in Pittsfield, Illinois. Shastid, a settler from New Salem, built this house in 1838. The house was added to the National Register of Historic Places in 2003.
John Shastid moved to Pittsfield, Illinois, built a house on his farmland, and became the Pike County Sheriff serving eight years. John saw Lincoln in several trials in court as a lawyer and in several Douglas debates. Lincoln often visited John's house and truly enjoyed Mrs. Elizabeth Brown Edwards Shastid's home-cooked meals.

John recognized the ocular condition as hyperphoria from a certain weakness of the muscles of the left eye, which continuously caused the eyeball to turn upward. Upon excitement, this condition would suddenly increase and produce a severe cross-eyed effect. John Shastid suggested that the hyperphoria caused intense eyestrain and uneasiness and was at least partly the cause of Lincoln's moodiness or "chronic inexpressible blues." John theorized that Abraham Lincoln was also colorblind, because Lincoln once told John’s mother, Nancy Elizabeth Greene, after she showed him her flower garden, that "flowers and sunsets have no beauty for me, as they do for other people."

Lincoln's right eye was dominant and was always used for vision, while the tendency of the left eye to turn upward and outward produced more or less overlapping of visual images. Like most such persons whose diplopia begins in youth, he soon adapted to this condition by reacting attentively to the imagery that he saw more clearly, that is, the image of the right eye while ignoring what the left eye saw. This required more or less volitional (the use of one's willpower) brainwork, which was carried on easily enough until manhood when at times mental visual fatigue or emotional strain became too severe.

Through the adult years, Lincoln had many nervous attacks, characterized by eyestrain, headache with nausea, and indigestion, so severe that he often became unable to work and had to lie down with a cold compress over his eyes. He had couches in his law office, at home, and in the White House for this purpose.

Probably in youth and maturity Lincoln was unable to focus both eyes for any length of time without volitional effort. Herein existed an unconscious, self-protective influence on conscious learning. He must not only use right-eyed instead of left-eyed vision, but he must consciously and conscientiously see mentally the right side and better side of things in order to reduce the emotional strain of being wrong. His highly persistent work in developing clear thinking, logically visualizing, auditizing, and verbalizing mind counteracted the mentally befuddling effects of diplopia and protected him against the tendency toward gloomy mental visualizing.

In 1857, at the age of 48, while shopping in a jewelry store, he bought, upon the recommendation of a friend, his first pair of "spectacles" for reading. He tried on several pairs and paid 37½¢ ($10.50 today) for the glasses that he read best with. Until a few years before he had probably normal vision and effective accommodation of the right eye, although the accommodation was always attended by more or less strain from discoordination of the left eye.

The following reports on Lincoln's eyes and glasses are taken from several later authoritative sources. In the early 1890s, the 37½¢ glasses were reported by Almer Dewitt Coe (1860-1956), owner of Almer Coe & Company Opticians, 65 State Street, Chicago (151 North State St. today), to have the same strength of +6.75 D in both lenses, indicating that Lincoln had hypermetropia (farsightedness, seeing distant objects clearly, but nearby objects are blurry) when Lincoln was 48 years old. This severe disability had no doubt been developing for a number of years and required constant mental and physical effort to produce sufficient accommodation for reading.

Dr. W.H. Crisp, an ophthalmologist, recorded the following observations: Full-face photographs show an upward deviation of the left eye, great enough to produce a lack of fusion of its images with those of the right eye. The two eyes did not work together, possibly as a result of vertical strabismus (a condition in which the eyes do not properly align with each other when looking at an object) of the left eye.

Dr. S. Mitchell found evidence of left hyperphoria and hypertropia and suggested that the corrugations of his brow and the crow's-feet at the corners of the eyes showed that Lincoln habitually used auxiliary facial muscles to support the external muscles of the eyes in the work of visual coordination.

Dr. K.C. Wold suggested that the diplopia was caused by a discoordination of the external muscles of the left eye, which was inherently connected in some way with the other facial asymmetries.

No physician on record, so far as we know of, has attempted to explain the origin and nature of the asymmetrical functioning of the facial and ocular muscles on the left side, although some have discussed the nervous effects of eyestrain.

All the known symptoms are explainable as the result of Lincoln’s boyhood skull fracture and brain injury from being kicked in the left forehead, above the eye, by a horse, producing permanent, specific forms of nervous discoordination (organic neurosis).

The continuous tendency to visual discoordination was sufficient to increase nervous fatigue and depression of mood or “spirit” upon prolonged use of the eyes, particularly for reading. Such conditions tend in most youths to induce discouragement of reading, lethargy with laziness, and a preference for reading from a reclining position to ease the eyestrain. Despite his impairment, Lincoln was an eager student and liked to lie on the floor and read aloud by the light of their wood hearth. Later, as a man, he often read in a reclining position on a couch or on the floor and preferred to read aloud.
Abe Lincoln reading by the fire at the family log cabin in Spencer County, Indiana.
We have additional evidence of how Lincoln's neuro-visual difficulties influenced him in everyday life. His work as a lawyer and politician required him to read excessively. He adapted to this by learning to scan pages rapidly for essentials and by developing a highly retentive memory. When it was unnecessary to use his eyes or mind, he would lapse into his characteristic semi-withdrawn mental state.

The right side of Lincoln's face was animated and emotionally expressive, whereas the left side functioned more weakly, looked duller, and was out of harmony. The meaning of the duality and changes in his facial expression baffled everyone. Strangers, who estimated the man by his dull, perplexed face and sad, tired eyes, were always astonished at the quick change of his expression to alertness when he became interested in their conversation and wanted to make some contribution to it. Many strangers, including lawyers, generals, and members of his cabinet, upon first acquaintance, thought themselves superior to this ugly, dull, sad, weak-looking man, only to find themselves amazed and mastered by the ready wit, common sense, logical intelligence, and strength of character that became evident upon his being required to look out for himself.

As his law partner from 1843 to 1861, William Herndon was no doubt the most frequent, intimate, and interested observer of Lincoln's personality and physical constitution day after day. He has stated that Lincoln's most marked and persistent characteristic was a predisposition to become melancholy or sad and depressed. This attitude showed in his facial expression when he was sitting alone or when he was in a group and not taking an active interest in the conversation. Many other intimate friends of Lincoln were similarly impressed, as recorded in various biographies. Some of his friends thought, because of the muddy, leathery condition of his skin, that this facial lapse was due to indigestion and insufficient secretion of bile.

Herndon imagined that the morbidity was caused by some “occult” condition, which could not be explained by observation or reasoning. It was “ingrained,” he said, and “could not be reduced to rules or the cause assigned... It was necessarily hereditary... It was a part of his nature and could no more be shaken off than he could part with his brains. Simple in carriage or bearing, free from pomp or display, serious, unaffected, Lincoln was a sad-looking man whose melancholy dripped from him as he walked.” Herndon observed that “the look of sadness was more or less accentuated by a peculiarity of one eye (left), the pupil of which had a tendency to turn or roll slightly toward the upper lid, whereas the other one maintained its normal position equidistant between the upper and the lower lids.” He also noticed that the tip of Lincoln’s nose and his mouth turned toward the right. “Mr. Lincoln was a peculiar, mysterious man-had a double consciousness, a double life. The two states, never in the normal man, co-exist in equal and vigorous activities though they succeed each other quickly. One state predominates and, while it so rules, the other state is somewhat quiescent, shadowy, yet living, a real thing. This is the sole reason why Mr. Lincoln so quickly, passed from one state of consciousness to another and different state” (letter from Herndon to J. Weik, Feb. 2, 1891.

Josiah Crawford (Herndon and Weik) remembered that as Lincoln became occupied with reading, his lower lip stuck out. This, he thought, was only a lifelong “habit.” Actually, as his mask (1860) and photographs show, the right half of the lower lip always protruded more than the left half and was pulled with the other muscles of the mouth slightly to the right side. When he was reading quietly or thinking actively, the degree of dominance in neuromuscular activity of the right side of his face tended generally to increase. When he was mentally inattentive, the lack of nervous stimulation tended to let the right side of his face decrease in activity faster than the relatively hypotonic left side, giving his expression a perplexed quality, which was misunderstood by those who would read his face.

Most persons with hyperphoria learn to disregard the dimmer, overlapping visual image without being conscious of such work. However, when eye strain and fatigue or emotional excitement grow excessive, the visual decoordination increases until the two more or less distinct images tend to be seen with increasing mental confusion and uneasiness. Lincoln learned to cultivate a calm, humorous, kindly attitude, happy interpersonal relations, and a common-sense philosophy of life, which generally protected him from emotional provocation and an increase of this distress. Yet he needed to have certain qualities of sympathetic excitation in order to maintain his best working pressure.

His description of a particular experience shows how he mystically interpreted his first experience with complete diplopia. Upon learning of his nomination for the presidency, in 1860, by the national convention of the young Republican party, Mr. Lincoln returned to his home, after a strenuous day, tired, and nervous, and lay down on a couch in his wife's sitting room to rest. Directly across the room, facing him, was a large mirror on the bureau. In it he saw for the first time a double image of his face, and it perplexed him greatly. He described the experience as follows:
As I reclined, my eyes fell upon the glass, and I saw distinctly two images of myself, exactly alike, except that one was a little paler than the other. I arose and lay down with the same result. It made me feel quite uncomfortable for a few minutes, but, some friends coming in, the matter passed from my mind. The next day while walking the street, I was suddenly reminded of the circumstance, and the disagreeable sensation produced by it returned. I had never seen anything of the kind before, and did not know what to make of it. I determined to go home and place myself in the same position, and, if the same effect was produced, I would make up my mind that it was the natural result of some refraction or optics, which I did not understand, and dismiss it. I tried the experiment with the same result; and, as I had said to myself, accounted for it on some principle unknown to me, and it ceased to trouble me. But the God who works through the laws of Nature might surely give a sign to me, if one of his chosen servants, even through the operation of a principle in optics.
Lincoln had been a devoted reader of the Bible since boyhood and superstitiously believed, as it taught by numerous episodes in many chapters, that God revealed his wishes and commands to chosen people by natural and occult signs, such as visions, voices, and dreams, as well as by the feelings of the heart and conscience. He said that he felt “to be aided and enlightened by One who is stronger and wiser than all others.”

Lincoln’s comments on his first experience with complete diplopia, as a double visual image of his face in a mirror, shows that, while he regarded it with common sense, it also excited him superstitiously, mystically, religiously, and wishfully. He hoped somehow to receive an inspiring sign, as a chosen servant of the people and of God, to think of a way of solving the violent conflict between the free and the slave states that would be acceptable to both sides and eventuate in the peaceful preservation of the Union. By his form of thought, feeling, belief, and faith in having received a definite sign and divine inspiration, he was able to maintain high, consistent integrity of purpose against the subconscious tendency to schizoid indecision and confusion.

He did not really dismiss this double vision of his face as being caused by a law of optics that he did not understand. It continued to mystify him, and he often thought of it. When he was President, after a dream, a few days before his assassination, in which he saw himself dead in state in the White House, he confided to Ward Lamon how he finally interpreted its premonitional meaning for his destiny. He would have two terms as President, and in the second term, he would be killed.

The collected photographs of Lincoln published by Frederick Hill Meserve and Carl Sandburg, and by Stefan Lorant, show that in many of them he has a similar serious, solemn, dignified, unsmiling but kindly, reposeful, mentally inactive facial expression. In a few, the face is so moody, depressed, and unusually perplexed, and the eyestrain so pronounced, that many people doubt whether they are authentic reproductions. Not until one examines the lines of the eyes, mouth, and skin closely in such photographs is the identity fully established.

Lincoln’s usual facial expression, when not being photographed, was that of patient humility, kindness, and naturalness of attitude, honesty, simplicity, and serenity of thought, with the tendency to smile pleasantly or to burst into a good-humored laugh. His face also showed great self-reliance, courage, and firmness, with thoroughgoing dignity and repose, when he was not tending to lapse into dull conscious detachment. The left side of his face, being less mobile and not in completely harmonious affective tone with the right, and contributing less volitional kinesthesis to his brain, was less truly representative of his state of mind.

The differences in expression seem to have influenced Lincoln, or his photographers, to prefer photographs of the right side of his face, since most photographs were taken from the right quarter or the profile. Only a few were taken from the left side or from the front. Although a great laugher, he tended to keep his mouth closed firmly, with more protrusion of the right lower lip than of the left when being photographed. Even though Mrs. Lincoln chided him for persisting in looking too solemn, he could not be persuaded to smile freely before the camera. Herndon said that from the moment Lincoln faced the camera his face would grow serious and sad.

Nausea and headaches from exacerbation of such continuous malfunctioning of the eyes are not uncommonly attended by a depressed, dark, gloomy outlook on life. Many ophthalmologists hold on physio psychologic grounds that the mental state follows from the physical condition, constituting primarily an organic neurosis. Most psychiatrists hold that, although such organic causes of visual malfunction tend to increase headaches and depression upon mental fatigue and emotional discouragement or excitement, the tendency to visual decoordination is psychopathologically increased by internal mental conflict and emotional depression or excitement, with the formation of a progressive vicious circle. Abundant evidence from the biographical study of Lincoln shows that the organic and emotional neuroses formed a vicious circle and worked pathologically, daily throughout his life and that he cultivated a common-sense attitude to protect himself from himself and his personal relationships that were largely successful but not infrequently broke down.

It is impossible to understand the effects on the development of Lincoln's personality of the injury to his brain in childhood without considering their connections with the conditioning influences of the different members of his family and his social and professional relationships. Conversely, we cannot estimate soundly his personal adjustments to the great crises of his life without correlating them with the organic factors in his neurosis. The thousands of biographical studies and estimations of Lincoln in books, papers, editorials, and speeches published since his death have largely been based on a fundamental misunderstanding of the determining factors in the development of the man's personality and his great motives, although many have estimated ably the part he played in history.

The studies of Lincoln's facial expression made by physicians have related it to his ocular symptoms only as an auxiliary effort to control vision. The permanently destructive effects on his brain by the accident in boyhood, as the cause of his visual, facial, and vocal impairment and melancholic detachment, have been entirely overlooked. Of course, the definitive history of the accident and the dent in his forehead discredit the theory of cerebral injury at birth or of hereditary factors as the cause. A biography will be published soon giving special attention to the interactions of his organic and emotional neuroses with the origin and development of his great inspirations, leading up to and including his Presidency. It will show for the first time how the cerebral injury and family environment in boyhood influenced the development of his personality and mental convictions as a man.

Because of limited space, it must suffice here to add the well-known fact that Lincoln (born and raised in a wilderness log cabin) had an unusually attractive, intelligent, heroic, although semiliterate mother, to whom he was greatly attached in childhood. She died tragically of an epidemic fever when he was 9 years old, and his father married again when he was 10. His stepmother, an unusually intelligent pioneer woman, was very kind and devoted to her stepson and encouraged him to learn to read and write and to educate himself. He always retained a persistent, gloomy mother fixation, with interest in melancholy and tragic songs and poetry about the dead and the past.

His betrothed, Ann Rutledge, died in 1837 of an epidemic fever, and he reacted with suicidal melancholia, which lasted for several months. The following year he courted Mary Owens and proposed marriage but was unable to complete this obligation because of conflicting emotional revulsions against it.

In 1840 he courted Mary Todd and suffered such intense schizoid depression that he was unable to appear for the wedding ceremony. He again became melancholic, incoherent, and suicidal but recovered sufficiently in a few weeks to return to his office. He married Mary Todd in 1842; but, although she had four sons by him, he was never able to love her. He continued to have repeated attacks of emotional nervousness, with headaches and indigestion, for the rest of his life, particularly when forced to endure some grave political or military frustration.

Abraham Lincoln, throughout his maturity, until his death, was never free for a day from the tendency to melancholy from the combined interactions of an organic visual neurosis and a specifically, conditioned, emotional neurosis that worked in a repetitive, vacillating, vicious circle, against the miserable effects of which he protected himself by cultivating a practical, common-sense philosophy of humanism and humor.

By Edward J. Kempf, M.D.
Edited by Neil Gale, Ph.D.

[1] Diplopia is the perception of 2 images of a single object. Diplopia may be monocular or binocular. Monocular diplopia is present when only one eye is open. Binocular diplopia disappears when either eye is closed.

[2] Astigmatism is a type of refractive error in which the eye does not focus light evenly on the retina. This results in a distorted or blurred vision at any distance. Other symptoms can include eyestrain, headaches, and trouble seeing at night.

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