“What an Affliction”: Mary Todd Lincoln’s Fatal Pernicious Anemia

This is the most comprehensive description of pernicious anemia I have read from John G. Sotos. Click here to learn more or read an excerpt below.


To date, no single diagnosis has unified the psychiatric illness and the numerous poorly defined physical complaints that Mary Lincoln (née Todd, 1818–1882) suffered in adulthood. Here, I show that her physical ailments spanned 30 years and included sore mouth, pallor, paresthesias, the Lhermitte symptom, fever, headaches, fatigue, resting tachycardia, edema, episodic weight loss, progressive weakness, ataxia, and visual impairment. Long thought hypochondriacal, these findings, plus their time course and her psychopathology (irritability, delusions, hallucinations, with preserved clarity), are all consistent with vitamin B12 deficiency. Pernicious anemia most probably caused this deficiency: she lacked risk factors for other causes, and her consanguineous parents both derived from a region of Scotland having a high incidence of pernicious anemia. A diagnosis of chronic multisystem pernicious anemia would clarify the conduct of Mary Lincoln as First Lady and widow, and illuminate challenges faced by her husband, President Abraham Lincoln. Her case highlights many forgotten features of the natural history of untreated pernicious anemia and is unique in the medical literature in demonstrating such a course extending over a lifetime.


paresthesias – an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves.

Lhermitte symptom – It lasts just a few seconds, but it can be startling: An intense burst of pain like an electric shock that runs down your back into your arms and legs when you move your neck. It’s called Lhermitte’s sign, or barber chair sign, and it’s often one of the symptoms that people mention when they’re first diagnosed with multiple sclerosis.

resting tachycardia – Tachycardia refers to an abnormally fast resting heart rate – usually at least 100 beats per minute.

edema – a condition characterized by an excess of watery fluid collecting in the cavities or tissues of the body.

Ataxia – is a lack of muscle coordination which may affect speech, eye movements, the ability to swallow, walking, picking up objects and other voluntary movements. A person with persistent ataxia may have damage in the part of the brain that controls muscle coordination – the cerebellum.

consanguineous parents – having the same ancestry or descent; related by blood.


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