Charles Darwin's illness

For much of his adult life Charles Darwin's illness repeatedly affected him with an uncommon combination of symptoms, leaving him severely debilitated for long periods of time, incapable of normal life and intellectual production, staying in bed most of the time for months. Charles Darwin wrote that "Constant attacks....makes life an intolerable bother and stops all work".

He consulted with more than 20 doctors, but with the medical science of the time the cause remained undiagnosed. He tried all available treatments, but at best they had only temporary success. More recently, there has been much speculation as to the nature of his illness.

Development of illness and symptoms
As a student of medicine at Edinburgh University Darwin found that he was too sensitive to the sight of blood and the brutality of surgery at the time, so he turned his attention to natural history, an extra-mural interest he developed further when studying at the University of Cambridge to qualify as a clergyman. He then voyaged on HMS Beagle. During this survey expedition he suffered badly from sea-sickness during the eighteen months he was at sea, but he spent much of the 3 years 3 months he was on land in strenuous exploration. In Argentina at the start of October 1833 he collapsed with a fever. He spent two days in bed, then memories of a young shipmate who had died of the fever persuaded him to take a boat down river to Buenos Aires, lying ill in his cabin till the fever passed. On 20 September 1834 while returning from a horseback expedition in the Andes mountains, he fell ill, and spent the month of October in bed in Valparaiso. In his journal for 25 March 1835, while to the east of the Andes near Mendoza, he noted "an attack (for it deserves no less a name) of the Benchuca, a species of Reduvius, the great black bug of the Pampas" which is associated with Chagas' disease.

After the voyage ended on 2 October 1836 he quickly established himself as an eminent geologist, at the same time secretly beginning speculations on transmutation as he conceived of his theory. On 20 September 1837 he suffered "an uncomfortable palpitation of the heart", and as "strongly" advised by his doctors, left for a month of recuperation in the countryside. In the spring of 1838 he was overworked, worried and suffering stomach upsets and headaches which caused him to be unable to work for days on end. These intensified and heart troubles returned, so in June he went "geologising" in Scotland and felt fully recuperated. Later that year, however, bouts of illness returned - a pattern which would continue. He married Emma Wedgwood on 29 January 1839, and in December of that year as Emma's first pregnancy progressed, he fell ill and accomplished little during the following year.

For over forty years Darwin suffered intermittently from various combinations of symptoms such as malaise, vertigo, dizziness, muscle spasms and tremors, vomiting, cramps and colics, bloating and nocturnal flatulence, headaches, alterations of vision, severe tiredness /nervous exhaustion, dyspnea, skin problems such as blisters all over the scalp and eczema, crying, anxiety, sensation of impending death and loss of consciousness, fainting, tachycardia, insomnia, tinnitus, and depression.

When writing to a new medical adviser, Darwin summed up his problems:

"Age 56-57. - For twenty-five years extreme spasmodic daily & nightly flatulence: occasional vomiting, on two occasions prolonged during months. Vomiting preceded by shivering, hysterical crying, dying sensations or half-faint. & copious and very palid urine. Now vomiting & every passage of flatulence preceded by ringing of ears, treading on air & vision. focus & black dots, air fatigues, specially risky, brings on the Head symptoms[,] nervousness when E[mma]. leaves me..."

He desperately tried many different therapies, within the limitations of medical science of his time. He took all kinds of medicines, including bismuth compounds and laudanum and even tried quack therapies, such as electrical stimulation of the abdomen with a shocking belt.

The only procedure that had much effect was a drastic water therapy regimen at Dr James Gully's Water Cure Establishment at Malvern, which he took up enthusiastically and continued for four years. This involved cold showers, vigorous rubbing and body strapping with wet towels, and lots of water drinking. He began the treatment in March 1848, and despite his suspicions of quackery the cure worked. After sixteen weeks at the spa he continued the treatment at home, but the excitement of a meeting of the British Association brought back the sickness and he returned for further treatment. This cycle of treatment and relapse was repeated. At the end of June in 1850 his fears that his illness might be hereditary were reawakened when his nine-year-old daughter Anne Darwin suffered a long illness. She was treated at the spa, but died on 23 April 1851. He had kept records of the effects of the continuing water treatment, and in 1852 stopped the regime, having found that it was of some help with relaxation but overall had no significant effect, indicating that it served only to decrease his psychosomatic symptomatology. He continued to try various experimental therapies without any confidence in their effects, and at times of illness often tried spa treatments with limited success.

Darwin himself wrote of his illness, emphasising that it was brought on by 'excitement': "Few persons can have lived a more retired life than we have done. Besides short visits to the houses of relations, and occasionally to the seaside or elsewhere, we have gone nowhere. During the first part of our residence we went a little into society, and received a few friends here; but my health almost always suffered from the excitement, violent shivering and vomiting attacks being thus brought on. I have therefore been compelled for many years to give up all dinner-parties; and this has been somewhat of a deprivation to me, as such parties always put me into high spirits."

"Of late anything which flurries me completely knocks me up afterwards, and brings on a violent palpitation of the heart."


 * The life and letters of Charles Darwin 1887 p 79  and p 287.

Possible causes
Medical science has tried repeatedly to pinpoint the etiology, and many hypotheses were made, such as:


 * Psychosomatic disease
 * Panic disorder


 * Chagas' disease
 * Ménière's disease
 * Lactose intolerance
 * Lupus erythematosus
 * Arsenic poisoning
 * Multiple allergies
 * Hypochondria

Psychic causation
Darwin found that his illness often followed stressful situations, such as the excitement of attending a meeting. Having escaped "smoky dirty London" to his country retreat of the former parsonage of Down House at Downe, he became increasingly reclusive, actually fitting a mirror outside the house, so that he could withdraw when visitors were coming around the corner. When he left it was mostly to visit friends or relatives, though he did endeavour to meet his obligations to attend scientific meetings.

Diagnosis of panic disorder and agoraphobia
These circumstances are today considered symptomatic of social phobia (fear of social contact) and agoraphobia (in the sense of fear of social gatherings or visitors outside a defined space they feel in control of); this supports a diagnosis of panic disorder.

Barloon and Noyes report that as a young man, Darwin had "episodes of abdominal distress, especially in stressful situations". He had a "premorbid vulnerability" which in his youth was referred to as "sensitivity to stress of criticism in his youth." They contend that "variable intensity of symptoms and chronic, prolonged course without physical deterioration also indicate that his illness was psychiatric." Panic disorder usually appears in the teens or in early adulthood with an association with potentially stressful life transitions. The histories of panic disorder patients often include some type of separation from a person who is emotionally important to them, which may be significant as Darwin's mother died in 1817 when he was eight, though apparently Darwin had a happy childhood overall and was encouraged by his siblings. Bowlby suggested that separation anxiety may help cause the development panic disorder in adulthood and that agoraphobic patients frequently describe parents as dominant, controlling, critical, frightening, rejecting, or overprotective, which matches (disputed) descriptions of Darwin's father as tyrannical (see below).

A study by Chambless and Mason says that regardless of gender, the less masculine in trait a person afflicted with panic disorder is, the more likely they are to use avoidance (social withdrawal) as a coping mechanism. Individuals who have a more masculine traits often turn to external coping strategies (for example, alcohol). Dr. Bean wrote that while Darwin had great confidence, at the same time he was neurotic, became nervous when his routine was altered, and was upset by a holiday, trip, or unexpected visitor.

Colp disputes a diagnosis of agoraphobia, because Darwin dutifully attended 16 meetings of the Council of the Royal Society and was away from home about 2,000 days between 1842 and his death in 1882, but Barloon and Noyes state that Darwin only left home infrequently, usually accompanied by his wife. They cite Darwin declining an invitation; "I have long found it impossible to visit anywhere; the novelty and excitement would annihilate me".

Psychosomatic disease, social withdrawal, and isolation may also be a result of some debilitating organic disease. Hypochondria could be present and represent an exacerbation of organic disease. Darwin described in great length and in extreme clinical detail his suffering in his diaries (he went to the extreme of recording daily the volume and quality of his tinnitus). It is hard to tell whether some of his mostly subjective observations were real or imaginary.

Relationship with father
Rempf imputes a psychic cause based on the theory of Oedipal complex, proposing that Darwin's illness was "an expression of repressed anger toward his father" (the physician Robert Darwin). Rempf believed that Darwin's "complete submission" to a tyrannical father prevented Darwin from expressing anger towards his father and then subsequently toward others. In a similar diagnosis English psychiatrist Dr. Rankine Good stated, "Thus, if Darwin did not slay his father in the flesh, then he certainly slew the Heavenly Father in the realm of natural history", suffering for his "unconscious patricide" which accounted for "almost forty years of severe and crippling neurotic suffering." Sir Gavin de Beer disputed this explanation, claiming a physical causation.

Darwin's autobiography says of his father, "... [he] was a little unjust to me when I was young, but afterwards I am thankful to think that I became a prime favourite with him." Bradbury quotes J. Huxley and H.B.D. Kettlew; "The predisposing cause of any psychoneurosis which Charles Darwin displayed seems to have been the conflict and emotional tension springing from his ambivalent relations with his father ... whom he both revered and subconsciously resented." and John Chancellor's analysis; "... [Darwin's] obsessive desire to work and achieve something was prompted by hatred and resentment of his father, who had called him an idler and good-for-nothing during his youth."

Such psychoanalysis remains controversial, particularly when based only on writings.

Relationship with wife, nervousness about being left alone
Peter Brent's biography "Darwin: A Man of Enlarged Curiosity" writes that Charles and Emma Darwin's "ties to each other were linked to childhood and the very beginnings of memory. They had a common history, a joint tradition. It is hard to think their relationship a passionate one, but it was happy, and the happiness had deep roots." Bradbury - himself a social psychologist - draws on this biography to argue that in Darwin's letters, Emma was "always the mother, never the child, Darwin always the child, never the father." who gave his wife the nickname "mammy", writing "My dearest old Mammy ... Without you, when sick I feel most desolate .. Oh Mammy, I do long to be with you and under your protection for then I feel safe." Brent states that it is difficult to see that that this is a thirty-nine year old man writing to his wife and not a young child writing to his mother. Barloon and Noyes quote Darwin's admission to Dr. Chapman of "nervousness when Emma leaves me" which they interpret as a fear of being alone associated with his panic disorder.

Like his mother, Darwin's wife Emma was devoutly Unitarian. His father, speaking from experience, warned Charles before he proposed to Emma that "some women suffered miserably by doubting about the salvation of their husbands, thus making them likewise to suffer." Darwin did tell Emma of his ideas at that stage, and while she was deeply concerned about the danger to his afterlife expressed in the Gospel "If a man abide not in me...they are burned", she married him and remained fully supportive of his work throughout their marriage. She read and helped with his "Essay" setting out his theory in 1844, long before he showed his theory to anyone else. She went through the pages, making notes in the margins pointing out unclear passages and showing where she disagreed. As his illness progressed she nursed him, restraining him from overworking and making him take holiday breaks, always helping him to continue with his work.

Religious tension
Darwin had a complex relationship to religion. The Darwin — Wedgwood family were of the Unitarian church, with his grandfather Erasmus Darwin and father taking this to the extent of Freethought, but in the repressive climate of the early 19th century his father complied with the Anglican Church of England.

Charles Darwin's education at school was Anglican, then after in Edinburgh he joined student societies where his tutors espoused Lamarckian materialism. He liked the thought of becoming a country clergyman, and before studying at the University of Cambridge, "as I did not then in the least doubt the strict and literal truth of every word in the Bible, I soon persuaded myself that our Creed must be fully accepted." The clergyman naturalist professors there who became his lifelong friends fully accepted an ancient earth, but opposed evolutionism which they felt would undermine the social order. He did well at theology and in his finals came 10th out of a pass list of 178. At both universities he saw how evolution was associated with radicals and democrats seeking to overthrow society, and how publicly supporting such ideas could lead to destruction of reputation, loss of position and even imprisonment for blasphemy.

At Cambridge he was convinced by William Paley's writings of design by a Creator, but on the Voyage of the Beagle his findings contradicted Paley's beneficent view. On his return his deepening speculations led to the inception of Darwin's theory, and he increasingly disbelieved in the Bible, gradually becoming what was later termed an agnostic.

Darwin was clearly worried by the implications of his ideas and desperate to avoid distress to his naturalist friends and to his wife. When first telling his friends he wrote "it is like confessing a murder", and his writings at the time of the publication of Darwin's theory suggest emotional turmoil. What is unclear is whether this was anxiety about disgrace and damage to his friends, or about his loss of faith in Christianity, or indeed a rational fear of the harsh treatment he had seen meted out to radicals and proponents of evolutionism.

The Chagas hypothesis
Advanced for the first in time in 1959, by eminent Israeli specialist in tropical medicine, Dr. Saul Adler, from Hebrew University, the hypothesis of Chagas disease was based partly on the fact that during the Voyage of the Beagle Darwin was bitten by the insect vector of this disease near Mendoza to the east of the Argentinian Andes while on one of his land exploration trips. According to his own words, in the journal for 25 March 1835:


 * "At night I experienced an attack (for it deserves no less a name) of the Benchuca (Vinchuca), a species of Reduvius, the great black bug of the Pampas. It is most disgusting to feel soft wingless insects, about an inch long, crawling over one's body. Before sucking they are quite thin but afterwards they become round and bloated with blood."

Arguments for the Chagas hypothesis were mainly his gastric symptoms and some of his nervous signs and symptoms (caused in Chagas by an imbalance of the autonomic nervous system), malaise and fatigue, as well as his ultimate cause of death, which seems to have been chronic cardiac failure (present in ca. 20% of Chagas patients, with cardiomegaly and ventricular tip aneurysm), accompanied by lung edema.

Evidences against the Chagas hypothesis are numerous, however:


 * Darwin died at a relatively old age for his time (73 years old);
 * The symptoms abated as he aged, which is not typical for the disease, where age exacerbates the symptoms.
 * He didn't seem to have several of the pathological damages present at chronic Chagas disease, such as megacolon and megaesophagus;
 * Some of the symptoms such as tachycardia, fatigue and tremors were already present before the Beagle voyage;
 * The numerous partial exacerbations and remissions are unusual in Chagas disease;
 * The incidence of Trypanosome-infested benchucas in Mendoza, Argentina (which has a colder climate), where Darwin reported the bite, is very low;
 * No other members of Beagle's crew who accompanied Darwin in his land trip showed signs of a similar disease.
 * According to Dr. Bean "infection with T. cruzi occurs not from a bite but contamination of a bite with excreta".

Recently, unsuccessful attempts were made to test Darwin's remains for T. cruzi DNA at the Westminster Abbey by using modern PCR techniques, but were met with a refusal by the Abbey's curator. The attempt was the subject of a recent documentary of Discovery Health Channel.

Ménière's disease
The hypothesis of Ménière's disease has gained some unjustified popularity. A diagnosis of Ménière's disease is based on a series of symptoms, including some which were present in Darwin's case, such as tinnitus, vertigo, dizziness, nausea, motion sickness, vomiting, continual malaise and tiredness. The fact that Darwin did not suffer from hearing loss and that 'fullness' of the ears is never mentioned practically excludes Ménière's disease. The definition of this disease is however not very solid and some form of 'a-typical Ménière's disease' remains a remote possibility. Motion sickness was present throughout his life, and became apparent very early, when he suffered horribly of sea sickness during the whole Beagle voyage. Darwin himself had the opinion that most of his health problems had an origin in his 4-years bout with sea sickness. Later, he could not stand traveling by carriage, and only horse riding would not affect his health. Psychic alteration often accompanies Ménière's and many other chronic diseases. An argument put forward for a diagnosis of Ménière's is that Darwin hunted a lot when he was young and could have damaged his inner ear with the repeated noise of shooting. While it is not unlikely that the noise damaged the inner ear and caused tinnitus, it can not have caused Ménière's disease. While Ménière's disease patients suffer during vertigo attacks from sickness and vomiting, the 'dyspepsia' problems of Darwin have nothing to do with it. One of the diagnoses that he received from his physicians at the time was that of "suppressed gout"; the idea that this was an early name for Ménière's lacks any ground.

Other possible causes
Evidence for familial systemic lactose intolerance syndrome was that vomiting and gastrointestinal symptoms usually appeared 2-3 hrs after meals, and that apparently Darwin got better when he stopped taking milk or cream.

Food intolerance and lactase deficiency may also be confused with food allergies. Symptoms include difficulty swallowing and breathing, nausea, vomiting, diarrhea, and abdominal pain. Upon reaching several other organs in the body, allergens can cause hives, eczema, lightheadedness, weakness, hypotension, etc. This has been proposed as the source of Darwin's illness, but the hypothesis is improbable, because, as with lactose intolerance, its temporal and causal relationship with food is easily established, and this was not always the case.

Chronic arsenic poisoning (arsenicosis) has been considered too. This hypothesis has been advanced by John H. Winslow, who published a book arguing that Darwin took arsenic at low dosages as a remedy and that there was "a very close match" between his symptoms and those of arsenicosis. However, it is highly improbable too, due to the long duration of the illness (40 years), the abruptness of symptoms, the cause of his death, the absence of many symptoms and signs of this kind of poisoning (persistent weight loss and diarrhea, the appearance of dark brown calluses on the palms and the soles of the feet and of skin, known as hyperpigmentation).

Combined causes
From a clinical point of view, perhaps Darwin suffered from more than one disease, and had many psychosomatic complications and phobias arising from his debilitating condition. This is known to happen with many patients today, such as in severe cases of panic disorder, usually accompanied by hypochondria and depression.

Dr. Peter Medawar has supported the diagnosis that Darwin's health problems were part organic, part psychological. Colp concluded that Darwin's illness consisted most probably of panic disorder without agoraphobia, psychosomatic skin disorder, and possibly Chagas disease of the stomach" which he suggested "was first active and then became inactive, permanently injuring the parasympathetic nerves of his stomach and making it more sensitive to sympathetic stimulation and hence more sensitive to the "psychosomatic impact of his anxieties. An organic impairment best explains the lifelong chronicity of many of his abdominal complaints." Thus, the psychological aspects of Darwin's illness might be both a cause and an effect of Darwin's illness. D.A. B. Young noted in a Royal Society journal a 1997 that today the psychogenic view of Darwin's sickness "holds the field". The proponent of Chagas disease, Dr. Saul Adler, stated that Darwin may have suffered both from Chagas diseas and from "an innate or acquired neurosis".

Hereditary disease
Many of Darwin's children suffered from similarly vague illnesses for much of their early lives, but it has been speculated that part of this may have been simply because he encouraged a household where sickness was a form of attention and socialization. Darwin himself &mdash; concerned with heredity &mdash; wondered if he had passed on his general infirmary condition to his children, and was especially interested if his marriage to Emma Wedgwood, a cousin, was not perhaps also responsible (his concerns later in life with the effects of inbreeding were potentially motivated by this personal aspect as well).

Contribution to Darwin's work
Interestingly enough, it seems that Darwin's maladies actually may have contributed a lot to what many believe was a long and fruitful creative process in science. George Pickering in his book, "Creative Malady" (1974) wrote that isolated from social life and obligations of a "normal" scientist, such as administrative and teaching work, Darwin had ample time and material comforts for researching, thinking, and writing extensively, which he did. Despite the long periods of unproductivity caused by ill health, Darwin produced much research. Darwin often complained that his malady robbed him of a half lifetime, but even so, many believe that his scientific contributions can be compared favorably to those of such figures as Isaac Newton and Albert Einstein.

Darwin himself wrote about this, in his autobiographical "Recollections of the Development of my Mind and Character" (1876) :


 * Lastly, I have had ample leisure from not having to earn my own bread. Even ill-health, though it has annihilated several years of my life, has saved me from the distractions of society and amusement.

Conclusions
The exact nature of Darwin's illness or illnesses remain mysterious at this time. Unless sophisticated molecular probing of his biological remains is allowed, no definitive diagnosis can be reached. At the same time, historical investigations are probabilistic. There appears to be increasing support for the diagnosis that both organic and psychological ailments combined to cause his illness.

The issue has become embroiled in the creation-evolution controversy, with allegations that Creationists are drawing attention to interpretation of the illness to damage Darwin's reputation, and counter-allegations that admirers of Darwin refuse to accept faults in the man.

Notes and source

 * 1) This article is partly based on Renato M.E. Sabbatini's article "A Misteriosa Doença de Darwin", published on October 8, 1999. Reprinted with permission, extended and translated here by the author.
 * 2) The author translated and revised the Brazilian second edition of Desmond & Moore's biography of Darwin.