American Scientist

It is widely known that Charles Darwin was an invalid for the last 40 years of his life. But the fluctuating trajectory of his health presents something of an enigma. In his Autobiography, Darwin tells us that as a schoolboy he prided himself on his fast running. He became a dedicated sportsman, especially enjoying the shooting season. For two years at Edinburgh University he was quite healthy. As a student at Cambridge University he kept a horse so as to be able to get out into the countryside to collect insects. While traveling around the world on HMS Beagle (from 1831 to 1836), this athletic young man adventured fearlessly on horseback across much of South America. But soon after his return to England, where he took up a life as a geologist and a prolific author, he became a prematurely infirm recluse. Moreover, although his various illnesses were debilitating and he apparently suffered more pain than many mortals could have borne, he was prodigiously productive in science. The final puzzle is that no one has been able to identify what ailed him.

That Darwin suffered physical agonies cannot be disputed. But there were mental torments too. As a youngster, he was shy, stammered and had a weak stomach, especially at breakfast time. He was a loner, partial to long, solitary, self-absorbed walks. As a teenager he started to suffer outbreaks of eczema on his face and lips. These would cause him to hide away in his room for days at a time, full of self-loathing, shunning all company. In the mid-part of his time as a student at Cambridge he suffered from depression and his eczema worsened. To some of his fellow students he was an outgoing sportsman and great companion, but to others he appeared withdrawn and judgmental. From quite early on, Darwin said, intense emotion “knocked me up most dreadfully.”

The first apparent shift in his health occurred at Plymouth in 1831. No doubt he was already anxious enough about how he would endure a protracted voyage around the world in a tiny surveying ship. Then, during the agonizingly long, drawn-out wait for the Beagle to be ready for sea, he started to suffer not only from more dermatitis but also heart palpitations and, possibly, paresthesia (numbing of the finger tips). By contrast, during the voyage itself, he had a few fevers and a couple of long spells of intestinal illness, but perhaps no more than anyone would expect, given the conditions.

On Darwin’s return to England in October 1836, he set himself an ambitious schedule of work, starting with the completion of his Beagle diaries (published as Journal and Remarks in 1839 and later revised as The Voyage of the Beagle). He organized a battery of experts to create monographs of the zoological results of his work (The Zoology of the Voyage of H.M.S. Beagle, published in five parts between 1838 and 1843). All the while he was working intensely at establishing a place in London’s scientific community. Unsurprisingly, he soon added increased stomach problems to his list of ailments: “My stomach as usual has been my enemy.” He discovered that intense work also brought on headaches, palpitations, exhaustion and more eczema. Doctors, including his father, recommended that he work less, but any loss of time increased his anxiety.

Too Much Information!

Darwin accomplished so much in the two years after the Beagle voyage that one could hardly say that his health, severe as the symptoms might have been, had slowed him down (at least by the standards of mere mortals). From 1838, however, a new set of more debilitating symptoms appeared, and these were to dog him until the last few years of his life.

Darwin kept a detailed diary of his health and was always writing out lists of his symptoms for yet another doctor. The reports make lurid reading. For example, he reported in 1865: “For 25 years extreme spasmodic daily & nightly flatulence: occasional vomiting … tongue crimson in morning ulcerated … eczema—(now constant) lumbago.” Equally striking (and more shocking) is the fact that, after 1838, he suffered a range of psychological symptoms that appear directly related to anxiety: “shivering, hysterical crying, dying sensations or half-faint … singing of ears, rocking, treading on air, focus & black dots—All fatigues, specially reading, brings on these Head symptoms?? nervousness when E. [Emma] leaves me.” He was often exhausted; pain and gas woke him at night. He would lie awake and fret obsessively about his work: “… my nights are always bad & that stops my becoming vigorous.” He also became convinced, however, that bad bouts of eczema energized him.

Although it is almost embarrassing to know as much as we do about Darwin’s bodily functions and malfunctions, from the color and volume of his urine to the frequency of his bowel movements, he seems almost to have relished describing the details. I am reminded of the marvelous scene in the film The Madness of King George, in which a group of doctors pore over the contents of the royal chamber pot. Of all the symptoms, the ones that distressed Darwin most were the stomach pain, retching and flatulence—which seems always to have been in the form of belching. Things became so bad that a corner of his study was curtained off and provisioned with a basin and towels, where he would retire to suffer.

London’s most eminent doctors were consulted. Dyspepsia and “suppressed gout” were among their diagnoses. The remedies they proffered ranged from arsenic, to calomel (mercurous chloride) purges and doses of dilute muriatic (hydrochloric) acid or “spirits of salt”—hardly a wise choice for an acid stomach. Among other treatments he tried were “Condy’s Ozonized Water” (permanganate of soda) and the “Hydroelectric Chain” (the body was draped in brass and zinc wires wetted with vinegar, which produced small electric currents). Darwin became particularly enamored of various “cures,” and he spent months at a time at Dr. James Gully’s spa in Malvern and similar periods with Dr. Lane at Moor Park. First thing in the morning Gully’s patients would be rubbed with cold wet towels, they would drink cold water, and then they would walk. During the day the patients were draped with more cold wet sheets. Their feet were put in cold mustard water several times a day. There was a strict diet: Darwin wrote, “At no time must I take any sugar, butter, spices, tea, bacon or anything good.”

Most of the nostrums and treatments that Darwin tried (including ice-cold showers in the garden at home) would help for a while, but then their effect would stop. He avoided all stressful situations; he did not attend the funeral of his father or visit his Cambridge mentor John Stevens Henslow when he was dying. Overall, he did best when he eased his work load, restricted his diet, sat vertically, exercised gently and took a little wine at dinner. Since childhood he had had a craving, almost an addiction, for sugar, and he could never give that up, especially not the sweet dessert puddings that his wife served after meals.

The common denominators of Darwin’s illnesses were stress and his obsession with his symptoms and those of his family. He was afraid that he might have passed on his frailties and exacerbated them through inbreeding (his wife Emma Wedgwood was his first cousin). Darwin was more or less free of symptoms when not under stress, but an argument, the arrival of a visitor or a difficult period of intense cerebration would trigger an attack. And Darwin well understood the relationship between work and health: “I find the noodle [head] & stomach are antagonistic powers … (w)hat thought has to do with digesting roast beef—I cannot say.”

Undoubtedly a major factor in the trajectory of Darwin’s health was that, from mid-1837 onward, he had been secretly working on the potentially explosive subject of transmutation of species. It was, he later told Joseph Hooker, like “confessing a murder.” In 1838 he not only discovered the key to natural selection in his reading of Malthus, he also started to worry seriously about finding a wife. He began the year 1839 as a married man but with even more responsibilities.

Notably, as Janet Browne has documented in her wonderful biography, in between spells of work on intellectually difficult and politically contentious books such as On the Origin of Species (1859) or The Descent of Man, and Selection in Relation to Sex (1871), Darwin would regroup mentally by submerging himself in a botanical project and engaging in firsthand experimentation in the garden and greenhouse. For Darwin, working on such projects as The Fertilization of Orchids (1862) and The Movement and Habits of Climbing Plants (begun in 1864) was excellent therapy.

More Theories than Conclusions

Many books and articles have been written about Darwin’s afflictions. The latest and best of these is Darwin’s Illness by the psychiatrist Ralph Colp, Jr., a revision and extension of his To Be an Invalid, published in 1977. New readers of Colp’s work will be amazed at the depth of Darwin’s physical miseries and shocked at their persistence. They will perhaps be less surprised by the ineffectiveness of contemporary doctors or the primitiveness of their remedies.

Modern attempts to explain the causes of Darwin’s ill health often concentrate on its later manifestations and the dramatic “stomach” problems. As reviewed by Colp, the suggested causes range from hiatus hernia of the diaphragm to arsenic poisoning, lupus erythematosus, adrenal disease and giardiasis (a parasitic bowel infection, also known as the “beaver fever” of travelers). Recently, Crohn’s disease has been proposed, along with systemic lactose intolerance (a late-developing, secondary type). The last two would account for the exhaustion, pain and vomiting and might be alleviated by dieting, but they are usually associated with diarrhea, one of the few symptoms of which Darwin did not complain. Allergies have been proposed, among the more ingenious being an allergy to his experimental pigeons. None of these suggestions has proved fully satisfactory or convincing.

Colp, although recognizing the psychosomatic elements of Darwin’s illnesses, in addition favors the opinion that Darwin suffered from Chagas disease (a form of trypanosomiasis). Darwin was definitely bitten by the cinch bug vector (Triatoma infestans) in South America on at least one occasion, but he did not show the typical initial local infection that is caused by rubbing the bug’s excreta into the open bite. (All accounts say that, unlike malaria, Chagas is difficult to acquire from the bite alone.) Nor did Darwin display typical late symptoms, which has led Colp to propose that he suffered first a subclinical version and then a secondary manifestation.

Among conditions that have not yet been proposed or fully explored for Darwin, as far as I can determine, are hypoglycemia, celiac disease (allergy to wheat gluten) and gastroesophageal reflux disease. All three may show adult onset. Reflux is an interesting possibility because it is helped by sitting upright and also causes nighttime waking. In extreme manifestations, the pain, gas and cramping in the upper abdomen are severe. It is very sensitive to stress and, if unaddressed, its effects increase with time.

“I have given up all society”

Turning to the mental aspects of Darwin’s health, the child psychiatrist John Bowlby makes a good case that the illness and death of Darwin’s mother when he was only eight triggered in Darwin a morbid fear of sickness, loss and mortality. Certainly, throughout his life Darwin was almost unnaturally dependent upon the support of others. His brother Erasmus was a constant mentor, and through life he leaned heavily on a succession of others: Dr. Robert Grant at Edinburgh, his cousin William Darwin Fox and the Reverend Henslow at Cambridge, probably Captain FitzRoy during the early Beagle years, then Charles Lyell upon his return to London.

After he and Emma were married, Darwin was enveloped in a supportive cocoon of family and friends who catered to his every need. His illnesses may have become something of a crutch. The family’s ministrations both created an environment in which he could work and also reinforced the bonds of dependency. There was always someone to take care of him. Thomas Henry Huxley may have had Darwin’s domestic arrangements (and private fortune) in mind when he ironically noted, “If only I could break my leg, what a lot of scientific work I could do.” This aspect of Darwin’s life was well explored by George Pickering who, in his book Creative Malady, found parallels to Darwin’s condition in the lives of, among others, Florence Nightingale, Sigmund Freud and Elizabeth Barrett Browning.

Overall, the correlation between the most stressful events in Darwin’s life and his episodes of intestinal and dermatological ill health is too complete to ignore. Chronic anxiety would surely account for many of Darwin’s symptoms, starting with the facial eczema, palpitations and gastric distress. An argument could then be made that Darwin suffered first from a chronic anxiety syndrome compounded by poor diet and genuine alimentary malfunction, and then exacerbated over the years by hypochondria in a destructive feedback loop. We cannot, however, discount the presence of some additional condition such as Chagas.

In the final analysis, the story of Darwin’s illness or illnesses is rather like a mystery novel for which we lack the final chapter. Something might be learned if his remains were exhumed from Westminster Abbey, but I suspect we would still be disappointed. Darwin, who tried so hard to live in private, has become very much a public property. But even in this his bicentennial year we should perhaps be content to allow him some remaining secrets.