－August 5, 2006 原作－

---不要在死人行列裡找Willie，他不在那兒-----

林肯雖是長相悲苦的總統，但是偉大的政治家，是黑奴的解放者，是苦心孤詣阻止分裂的愛國者，然而誤娶悍婦 ( Mary Todd ) ，林肯也是懼內會長 ( 他登壇備詢，面對國會常頭包紗布 ) ，也是 Marfan syndrome 的 suspected victim _[註1] ，當我們放大看他三個兒子，我們同情他也是苦難時代的好爸爸， ……

他娶 Mary Todd 那年，兩人分別是 33 vs . 23 y/o ，娶她前大個子 (6 ft 4 in : 193 cm ) 極其忐忑猶疑，問題不全在 Mary ，以當時女人連上學都難，她竟受高教，能操法語，彈鋼琴，娟秀能文， ……… 。當時都是罕見。經人牽線，他們被安排在社交舞會 ( Ball party ) 見，林肯趨前邀舞坦承舞藝不佳，舞罷陶小姐同意他並未謙虛 ( 踩到腳了？），他恐怕比 Yichun 還爛！之後他們約會了好一陣，皆尚文而輕武_[註2]，林肯再也不敢獻醜。

據後來 Mary 老姐回憶，他們多半聊天，談書談詩談時事政治 …… ，陶姝之悍其實早見端倪，因為她老是領導話題，大個子 ( 林肯比 Sean Connery 還 高２公分！ ) 只能乖乖當聽眾。

要說陶徳小姐後來變成強悍，用《存在決定意識》可能是說得通的：她生四個兒子，兩個死在手上，四個兒子三個夭折_[註3]……。林肯跟達爾文，距離 7000 多英哩（英美），卻同年同月同日生，都是水瓶座 (Mary Todd, 卻是射手 ) ，但是讓水瓶最驚駭難過的，竟是他最鍾愛的兒子 ( 老二 Willie ) 死在二月。

林肯有三子(Edward 4歲就走，所以扣掉不算）， Robert, Willie, 和 Thomas(TAD) ， 老大 Robert 幾乎不認識自己的家，先是上 Philips Exeter 寄宿學校（在 Exeter, New Hampshire），然後 Harvard ，連他弟弟過世，他也人在波士頓。 Willie 死時 12 歲，莫怪他爹媽最鍾愛， Willie 確屬傑出！他的學業極佳，恬靜莊重，有貴氣，尤其比起他弟弟來，更討爹媽喜。 Thomas (TAD), 微有口吃 (slight speech impediment_[註4]), 性急易怒，學業落後 (some what backward in his studies) 。因為醫學的斷層，連 Willie 的死因也模糊歧異。文獻上說是 Bilious fever, 這 bile 是中世紀醫學四體液說玄學(Four body fluid homeostasis）的 " 四體液" 之一，主管脾氣（沒錯！你沒聽錯，這是西醫，不是中醫的陰陽五行，那時的西醫就是這樣），而非今天的膽汁。其死因自瘧疾(malaria) 到傷寒(typhoid fever) 說法不等…… 。

我捧著傳記仔細端詳跨頁大相片里的小威利，只感覺天妒甘羅。他死在白宮里，連大內御醫群也束手，反證當年醫學的一籌莫展！林肯因內戰已經夠沉重，造化還這樣加碼鍛煉他的偉大（天將降大任于斯人也），實在殘忍。

林肯先被通知病危，他把白宮的官式活動暫停，等到他走過來待要進房探視，小 Willie 已經嚥氣了，他痛駭如冰，冷對遺骸良久，而黯然吶聲：可憐的孩子，這紛紛世界不配擁有你 (My poor boy, he was too good for his earth. ) 林肯把自己鎖在房間裡，任何人不見，左右聽到他長夜踱步飲泣 _[註5] ……。

Mary 雖然也痛不欲生，卻開始怕更壞的還在后面！--自己丈夫也跟著禍不單行！ 她請來 New York Francis Vinton 牧師，彼正因公幹在華府，牧師告訴總統 :

雖然傷逝痛苦是自然反應，但對於一個信神的基督徒，悲極自傷 (suicide? )是不可以的！是罪 (sin)。您的兒子，沒有死，他活在天堂裡……。

林肯吶吶地說 ： ……活著 ?　 還活著 ? ……

牧師說：您忘了嗎 ？ 福音裡豈不教導我們 ： 神不是死人的神，是活人的神，是仰望依靠神的所有人的神！ ……。

不要在死人行列裡找 Willie ，他不在那兒，他在天國里……。

Mary 也悲痛近狂，她黑紗罩衫整整穿了兩年……。

白髪人送黑髪人真是情何以堪，對於林肯夫婦，死的竟是兒子裡最愛最好的一個！更是命運最惡意的玩笑……我們固非顯宦，非 Lincoln ， Mary ，但愛子何遜 ?

兒子走了，要哈佛何用 ？我們在書縫裡讀出苦難時代的無奈與悲苦，看到貴為總統，卻在疾病面前一文不值，無比渺小！做父親的恨不能代子受難，卻喚不回生命……。愛子如痴的父親伸手五指，仍有短長……。天資容有賢愚,爹媽于 TAD 並無少愛，於 Willie 亦無獨厚，……。

Robert, Willie, Thomas merge together 就是每一個父母的--也包括我們--的寶，他們每一個都值得我們無保留地愛……連續幾天想ＸＤＲ家走了的孩子 ，卻突然 覺悟 父子母子在這其中要學的功課還很多，於是翻出林肯的故事。 爰為之記。

[註1]. Scientific American 1991 曾有專刊討論， PCR 及 LCR 使得用一小塊檢體（ tissue ）可以確認 Dx, 去年聽 Dr. Francesco Ramirez 講 Pediatric Grand Rounds ， Marfan Syndrome 指向 TGF- beta, 此說若證實，林肯懸案可以定錘。

[註2]. 美俚語取笑，這種約會叫 NATO，原來是北大西洋公約組織 North Atlantic Treaty Organization, 這里意指光說不練：No Action, Talk Only.

[註3]. Edward 活了4歲, Willie 12歲走, Thomas 18歲走。Thomas 官方記載是死于芝加哥大火，其實症狀是惡性肺積水(Malignant Pleural effusion)，一度被歸因為肺結核，但醫學上肺結核罕見積水，2008 Dr. John Sotos 花了２０年研究，將他們三者的死亡與林肯自己的病歷綜合討論，認為 MEN2B 最能完整解釋。但對媽媽 Mary Todd 而言，病理不能撫慰心理，她畢竟是親眼送走三個小孩，也親眼看見自己丈夫慘死。

[註4].Tad 有唇裂，即民間俗稱的兔唇，當代醫學知道唇裂手術須追加語言治療，但那個時代哪有這樣的概念，他的口吃諒與此有關，而先天唇裂對小小孩實在充滿挫折感，他的躁動易怒亦不無可能由此惡化

[註5]. 我覺得 Margaret Mitchell 的飄裡寫白瑞德喪女，實在是以林肯為藍圖 …… 。

突發奇想 ： Mary Todd 如果因為迭遭不幸，就來洗錢 ……，大概林肯的歷史定位會大不同，林肯畢竟是林肯。瑪麗陶德也不容易，她要是拿不幸作護符而理直氣壯撈錢， Booth 那兩槍就打得對，可惜 Booth 來臺南就槍法走樣，只打中肚皮……

Abraham Lincoln: A 1962 theory that Lincoln had Marfan syndrome has little currency today. According to a 2007 theory, it is more likely that he had a different disorder, multiple endocrine neoplasia type 2B

Marfan syndrome (Defined by Mayo Clinic)--

is an inherited disorder that affects connective tissue — the fibers that provide the framework and support for your body. As a result, Marfan syndrome can involve many different body systems, including your heart and blood vessels, eyes, and skeleton. The damage caused by Marfan syndrome can be mild or severe. The most serious effects of Marfan syndrome can be life-threatening.

People with Marfan syndrome are usually tall and thin, with disproportionately long arms, legs, fingers and toes. Some experts believe Abraham Lincoln may have had Marfan syndrome . According to the National Institutes of Health, Marfan syndrome occurs in at least one person per 5,000.

Marfans syndrome (defined by NIH/NCBI)
Described by Bernard Marfan in 1896, this autosomal dominant single-gene disorder results from a mutation of the fibrillin gene on chromosome 15 . The key clinical features are:

· arachnodactyly (long spindly fingers)

· high-arched palate

· pectus excavatum

· an armspan greater than height

· upward lens dislocation

· aortic root dilatation and aortic incompetence

· mitral valve prolapse

Marfan syndrome 和 TGF-beta

Ng CM, Cheng A, Myers LA, Martinez-Murillo F, Jie C, Bedja D, Gabrielson KL, Hausladen JM, Mecham RP, Judge DP, Dietz HC. 　　 TGF-beta-dependent pathogenesis of mitral valve prolapse in a mouse model of Marfan syndrome. 　　 J Clin Invest. 2004 Dec;114(11):1586-92.
Neptune ER, Frischmeyer PA, Arking DE, Myers L, Bunton TE, Gayraud B, Ramirez F, Sakai LY, Dietz HC. 　　 Dysregulation of TGF-beta activation contributes to pathogenesis in Marfan syndrome. 　　 Nat Genet. 2003 Mar;33(3):407-11. Epub 2003 Feb 24.

The Last - and Greatest - Lincoln Mystery

Its one of the most enduring mysteries in American history: What made Abraham Lincoln so tall, so thin, and so unattractive?

And what gave him his long limbs, large feet, high voice, odd lips, sluggish bowels, and astonishing joint flexibility? Why, in his last months, was he so haggard that editorials in major newspapers begged him to take a vacation?

These questions baffled Lincolns friends, and have intrigued historians and physicians.

Now, after 150 years, a ground-breaking book offers a remarkable solution that will forever change the way people look at Abraham Lincoln. It points to Lincolns DNA and the rare genetic disorder called MEN2B.

Written in clear non-technical language for the general reader, with more than 200 illustrations, The Physical Lincoln takes readers on a fascinating medical tour of Lincoln and his family. It reveals the diagnostic clues hidden in plain sight -- in photographs, plaster casts, drawings, eyewitness accounts -- and even the $5 bill.

The author, Dr. John Sotos, who spent 20 years affiliated with Johns Hopkins, examines Lincolns physical life in unprecedented detail and shows how the diagnosis of MEN2B up-ends several Lincoln myths:

• The early deaths Lincolns mother and three of his sons were not random bad luck.
• Lincoln was not depressed.
• Lincoln was not being ground down by war and responsibility.
• Lincoln was not physically vibrant as President: Advanced cancer would have kiiled him within a year, had he not been shot.

The Physical Lincoln is a fascinating Sherlock Holmes examination of a fascinating man. It offers fundamental new insights into Lincoln and brings you closer to him than ever before. A must-have book for history enthusiasts, it is also the perfect book to stimulate a young persons interest in science and medicine.

The Physical Lincoln: A Photo-Medical Solution to the Puzzle of Abraham Lincolns Height, Face, Pseudo-Depression, and Imminent Cancer Death.

(MEN IIB) , that caused skeletal features almost identical to Marfan syndrome.

In 2008, it was proposed that Tad died of medullary thyroid cancer that had spread (metastasized) to his chest cavity, causing a malignant pleural effusion (i.e. the fluid in his chest). This hypothesis, which explains all of Tads symptoms, derives from the conclusion that Tad and his father both had the genetic cancer syndrome called multiple endocrine neoplasia, type 2B (MEN2B). High-resolution photographs of Tad, taken over many years, show that he had masses in his lips, characteristic of MEN2B.