Back in the early ’80’s, when I wore a younger man’s clothes, I was an undergraduate reading Politics.

Thereused to be a dreadful joke doing the rounds that centred on the assassination of President Lincoln – the author of the Gettysburg Address. And one day I remember promising myself that I would read Lincoln’s Gettysburg Address in preparation for a lecture I was attending the next day.
So off I went to the library and found what I thought was a copy of the address. Unfortunately all I could find was a condensed version. And so I sought the help of one of the Librarians.

“Where can I get a copy of the full address?” I asked.

“That’s it” he said.

“No, no no, this must be the condensed version – it’s only 200 odd words long”

“That’s it”

And so I read the Gettysburg address on the way home on the bus. Now stay with me – this does get interesting I promise.

A few years later I visited Gettysburg (it has one of the few proper roundabouts in the States – you could buy a fridge magnet with ‘I rode the Gettysburg Rotary’ on it). Anyway what’s this got to do with Pernicious Anaemia? It’s all to do with the wife of the 16th President – Mary Todd Lincoln whose erratic behaviour has now been attributed to….Pernicious Anaemia. The ‘First Lady’ was prone to “A history of mood swings, fierce temper, public outbursts”. And she also imagined all manner of things happening to her.

When she visited one of her sons she told him that someone had tried to poison her on the train and that “a wandering Jew had taken her pocketbook but returned it later”. She was given to spending large amounts of money on refurbishing the Whitehouse and spent vast sums of money on clothes that she didn’t wear. Her behaviour became more unpredictable and after she nearly jumped out of a window to escape a non-existent fire,her son Robert determined that she should be institutionalised, which she was.

After she had witnessed her husband being assassinated in Ford’s Theatre in Washington DC in 1865 her behaviour became even more bizarre. This was just ten years after Thomas Addison had began his investigations into Pernicious Anaemia (Addison’s Disease) and so it was unlikely that anyone would have diagnosed her with the condition.

Now, there’s something that bothers me about all of this. We know from contemporary accounts that Mary was prone to violent outbursts and sudden mood swings. And we know that she was a spendthrift and imagined things. She also suffered from a wide range of other symptoms that indicate Pernicious Anaemia including ‘weakness, fatigue, fevers, headaches, gait problems, rapid heartbeat, mouth soreness, swelling and vision trouble’. Now all of these can be seen as indicators of Pernicious Anaemia but there doesn’t seem to be any evidence that she displayed the most common symptoms of PA – tiredness, fatigue, shortage of breath etc. Indeed contemporary authors talk of her ‘enormous energy’. Indeed, when her husband was assassinated (the President’s bodyguard had decided that the play wasn’t for him and that he’d pop next door for a cold one) it was 10:15 in the evening which is way past the bedtime for most patients with the disease. So whilst her behaviour and other physical symptoms can be attributed to being caused by PA it seems odd that nobody had ever commented on any tiredness of fatigue. If they had suspected Pernicious Anaemia there wouldn’t have been a reliable test to confirm the diagnosis; some things never change eh? Anyway Mary died of a stroke in 1882.

And the awful joke? Well here it is, just a little shorter than the Gettysburg Address:

“Apart from that Mrs. Lincoln, what did you think of the play?”

Told you it was awful…..