DARWIN AND ALL THOSE IDEAS
Dr Louis Heyse-Moore DM FRCP DHMSA
___________________________
Darwin’s ailments
•
Throughout his adult life, Charles
Darwin (1809-1882) suffered from
chronic, debilitating ill health
•
His doctors favoured nervous
dyspepsia or suppressed gout as
diagnoses
•
His varied treatments afforded only
temporary relief
•
Dozens of diagnoses have since been
suggested, none proven
Charles Darwin 1854.
Photo by Maull and Polyblank.
National Portrait Gallery
Gout in the family
Penelope née Foley = Charles Howard
1708-1748
1706-1771
Mary née Howard = Erasmus Darwin
1740-1770
1731-1802
Susannah née Wedgwood = Robert Darwin
1765-1817
1766-1848
Emma née Wedgwood = Charles Darwin
1808-1896
1809-1882
A drunkard, debauched and
prone to gout (according to
Erasmus Darwin)
‘3 fits of gout in three
successive years’.
Resolved on stopping alcohol
‘My father has had a bad fit of gout
together with a good deal of fever.’
(Charles Darwin)
‘Suppressed gout’ diagnosed by
his physicians
Darwin’s Symptoms – a sample of 24 letters
1837-1865: 95 symptoms
Desolate Dispirited Shattered condition Misery Thought of that time [Annie Darwin’s death] most
painful Old thoughts would revive so vividly Often wished to see the grave Hysterical crying
Nervous when E. leaves me This scene [a soldier's burial] deeply stirred whatever poetic fancy there
was in me Amnesia Dissociation Flashbacks Avoidance places associated with trauma Difficulty
concentrating Social withdrawal Rigid routine Rocking Treading on air Indifferent health Emma
Darwin’s confinement knocked me up Sudden attack Good for nothing Bad all winter Unwell Bad
enough Most think I am shamming Quite ill Sick boy Steadily going downhill Uncertain health
Smallest exertion most irksome No spirits to do anything Want vigour Mental fatigue or rather
excitement Weak Languid Excessively tired Not able to do anything Overtired with my work Good
way from being a strong man Unable to write Cannot speak Cannot walk above half-mile
Conversation or excitement tire me most Dying sensations I thought I was rapidly going the way of
all flesh I hope my life may be very short Pain about the heart Uncomfortable palpitations Pulse 5862 or slower and like thread Periodical vomiting Stomach bad Speaking at the Linnaean Society
brought on 24 hours vomiting Vegetable cells in the limpid fluid I throw up Bad amount of sickness
Nausea Extreme spasmodic daily and nightly flatulence Extreme secretion of saliva with flatulence
Vomit intensely acid, slimy (sometimes bitter) corrodes teeth Tongue crimson in morning intensely
ulcerated Stomach constricted dragging Fundament – rash Cold stomach when sick Faint Half faint
Slept too heavily Sleepless night Head often swimming Nervous system affected I felt as if my body
was gone & only my head left Weakened my brain Head symptoms Seldom headach pins and
needles vision. focus and black dots Fiery spokes Dark clouds Now constant lumbago My lips
became suddenly so bad Dreadful numbness in my finger-ends Excessive irritation of skin Eczema
Eruption all over legs Violent skin inflammation My hands are burning as if dipped in hell-fire Feet
coldish Copious very palid (sic) urine Urine scanty (because do not drink) Pinkish sediment when
cold Singing of ears Whizzing Sharpish shivery Slight shaking fit Hands tremulous 
Some proposed causes of Darwin’s illness
Physical Causes
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Chronic neurasthenia of a severe grade (1901)
Refractory anomaly of the eyes (1903)
Mental overwork (1955)
Brucellosis (1958)
Chagas’ Disease (1959)
Syndrome of narcolepsy and diabetic
(functional) hyperinsulinism (1967)
Arsenic and mercury poisoning (1971)
Immune system dysfunction (1990)
Hypoadrenalism and hypoglycaemia (1994)
Systemic lupus erythematosus (1997)
Ménière’s Disease (1997)
Atopic eczema (2000)
Systemic lactose intolerance (2005)
Crohn’s Disease (2007 and 2014)
Cyclical Vomiting Syndrome (2009)
Helicobacter pylori infection (2011)
MELAS syndrome (2013)
Psychological causes
•
•
•
•
•
•
•
Psychoanalytic interpretations (hostility to
his father) (various dates)
Anxiety neurosis (1918)
‘A mild form of depression’ (1959)
Psychosomatic illness caused by the
controversial nature of his evolutionary
theory (1974)
Hyperventilation syndrome (1990)
Failure to grieve for his mother leading to
depression (1990)
Panic disorder with agoraphobia (1997)
See handout
Some published diagnostic hypotheses on Darwin’s
illnesses: Chagas’ Disease (Adler 1959)
•
•
•
•
•
Darwin reported in his South American Journal of 26 March
1835: ‘At night I experienced an attack (for it deserves no less
a name)... of the great black bug of the pampas. It is most
disgusting...’
A protozoal infection by Trypanosoma cruzi, carried by a bug,
Triatoma infestans, affecting the gut and heart, common in
South America
Late manifestations such as a grossly swollen gut and dilated
cardiomyopathy, do not fit with Darwin’s symptoms
However, a chronic low-grade form can also occur
Darwin, C.R. (1860a) Journal of Research During the Voyage of
H.M.S. ‘Beagle.’ Edinburgh: T. Nelson & Sons.
The Beagle
MELAS Syndrome
(Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes)
•
•
•
•
•
•
•
•
•
Caused by gene mutation in
mitochondrial DNA.
Maternal inheritance
Darwin’s family had a history of
chronic unexplained illnesses
First described 1984
Rare multisystem disease with
multiple symptoms
Typically starts in childhood with
muscle weakness and pain
Headaches, extreme fatigue,
vomiting, fits, strokes, dementia
Survival is usually a few years from
onset of symptoms
A less severe form beginning in
adulthood can occur
Hayman JA. Darwin’s illness revisited. British Medical
Journal 2009; 339: b4968
Hayman JA. Charles Darwin's mitochondria. Genetics 2013;
194: 21-5.
Crohn’s Disease
•
On the 2nd April 2014, a Channel 4 documentary 'Dead Famous
DNA' revealed that hairs from Darwin's beard had undergone
DNA analysis, and showed 'twenty-one markers for Crohn's
disease, five of them being diagnostic, including the major marker
Burrill B. Crohn (1884-1983):
described Crohn’s disease in 1932
of chromosome 16.’
•
Half of Darwin’s DNA extracted. Genes associated with baldness,
enhanced memory and thrill-seeking found but no other illnesses.
•
Cross-matched with members Darwin’s family.
•
This is the only hypothesis so far backed by clinical investigation.
All the others depend on reported symptoms and signs.
Orrego F, Quintana C. Darwin’s illness: a final diagnosis. Notes and Records of the Royal Society
of London 2007; 61: 23-29.
Jefferies M. Channel 4 documentary Dead Famous DNA revealed Charles Darwin suffered from
Crohn's disease. The Daily Mirror, 1 April 2014, http://www.mirror.co.uk/tv/tv-news/deadfamous-dna-charles-darwin-3337775
Crohn’s disease – left-sided colitis
with typical cobblestone appearance
Hypothesis
Charles Darwin 1868 –
photo Julia Margaret Cameron
Edvard Munch – Death in the Sick Room
Charles Darwin suffered from chronic post-traumatic stress disorder
(PTSD). This began as developmental trauma when his mother died and
progressed in adult life to PTSD following further traumas
1817: Catherine Wedgwood’s memories of
her dying sister, Susannah Darwin
It is impossible to have a worse account than I have to give
you. The Dr. has not the slightest hope & her suffering is
terrible. The pain indeed is gone that was her first illness,
but she has such severe vomittings, & sickness that he says
he does not think her sufferings much lessened... This
evening she is worse...[Her daughters] are always with her...
Her senses are as perfect as ever. From feebleness she can
hardly speak.
[Next morning] After a wretched night my poor sister yet
lives, but the mortification is far advanced & must soon be
fatal.
Ref: Wedgwood, C. (1817) Letter to Josiah Wedgwood II. 14 July 1817. Wedgwood
Archives 19835-27.
Susannah (riding) and
Catherine Wedgwood when younger
– from a portrait of the
Wedgwood family by George Stubbs c.1780
1817: Darwin’s dissociation – a
protective psychological state
I had, as a very young boy, a strong
taste for long solitary walks; but what
I thought about I know not. I often
became quite absorbed, and once,
whilst returning to school on the
summit of the old fortifications round
Shrewsbury, which had been
converted into a public foot-path
with no parapet on one side, I walked
Magritte
off and fell to the ground, but the
height was only seven or eight feet.
Darwin C. The autobiography of Charles Darwin. E
Barlow, ed. London: Collins, 1958: 25.
‘Mr Duffy lived a short distance from his body.’
James Joyce (1914) Dubliners
1825: Alterations in arousal and
reactivity
• However, Darwin was not
entirely a helpless victim.
When he was 16, he ‘became
passionately fond of
shooting... I remember killing
my first snipe, and my
excitement was so great that I
had much difficulty in
reloading my gun from the
trembling of my hands.’
(Darwin 1958).
• Browne (1995) comments on:
‘The resulting bloodbath of
animals – partridges, pigeons,
rabbits, rats – which he killed
with violent pleasure...’
Thomas Smythe (1825-1906)
Duck shooting watercolour 1889.
1825: Flashbacks
‘I also attended on two occasions the
operating theatre in the hospital... and saw
two very bad operations, one on a child, but I
rushed away before they were completed.
Nor did I ever attend again, for hardly any
inducement would have been strong enough
to make me do so... The two cases fairly
haunted me for many a long year.’(CD)
He was left with ‘a [permanent] morbid
Unknown artist. Amputation,
Old St Thomas’s Hospital.
1775. Royal College of Surgeons
horror of the sight or even the word blood’
(according to his son, George Darwin)
His illness begins
• 1838 Episodes of being
‘unwell’
• 1839 Marries Emma
Wedgwood
• December 1839 vomiting
and flatulence begin
• 27 December 1839 his
son, William, born
• March 1840 resigns from
position as secretary of
Geological Society
because of ill health
The Darwins’ first house (No. 12 on left),
Upper Gower Street, London
The death of Annie Darwin, 1851,
aged 10 years, in Malvern
•
•
•
•
Annie’s illness, though fluctuating
daily, and despite the water cure,
advanced inexorably and Darwin’s
letters to Emma chart his emotional
peaks and troughs. Annie developed
severe diarrhoea. ‘As she lay writhing
helplessly, his own stomach gave way,
and he ran from the room, convulsed
and retching.’
Her death certificate: ‘Bilious fever
with typhoid character.’
Two more of his children later died in
childhood.
Desmond, A. & Moore, J. Darwin, 1991, p.383
Origins
• The research on and
conceptualisation, writing
and publication of The
Origin of Species was to
cause Darwin much mental
anguish over many years
• Already vulnerable from his
past traumas, he was prey
to chronic symptoms of
psychological distress
• His mood and symptoms
usually improved when he
took the Water Cure and
ceased working on his book
Charles Darwin’s study,
Down House
Alfred Russel Wallace – an unexpected and unwelcome catalyst
Alfred Russel Wallace and his friend
Frederick Geach February 1862, Singapore
Malay Archipelago – the scene of Wallace’s
natural history expeditions
18 June 1858 – Darwin receives an essay ‘On the Tendency of Varieties to Depart Indefinitely from
the Original Type,’ from Wallace writing from Malay.
Darwin comments ‘he could not have made a better short abstract’ (of the theory of evolution)
Darwin is horrified. His decades of unpublished research have been overtaken.
1858 Emotional storm clouds
•
•
•
•
•
•
•
•
•
•
Origins has been pre-empted
Darwin wrestles with his conscience on priority of
publication
He agrees to a joint presentation at the Linnean
Society
Etty, his daughter, is seriously ill with diphtheria as is
her nurse
Charles Waring, his baby son ‘backward in walking
and talking’ dies of scarlet fever and his nurse
contracts the same illness
There are fears (soon justified) of an outbreak of
scarlet fever in the village
Charles and Emma move their children to a safe
location
Darwin stays at home, ‘grief-stricken and ill’
He and Emma bury their son while the Linnean
meeting is in progress
This absence was to be a repeating pattern over the
years at future meetings
1857 Charles Waring Darwin (b 1856)
and Emma. He is thought
to have had Down’s Syndrome
Henrietta Darwin
1859 Publication of The Origin of
Species
First edition. Natural History Museum, London
1860 – The British Association Debate,
Oxford
JD Hooker
TH Huxley, Darwin’s bulldog
Bishop Samuel Wilberforce,
Bishop of Oxford
‘Soapy Sam’
The famous debate in which Huxley and Hooker passionately
defended evolution and Wilberforce spoke against it.
Darwin was not present. He was away taking
the Water Cure at the time
Darwin’s medical note to Dr Chapman,
20 May 1865
University of Virginia Library, Albert and Shirley Small Special Collections Library, Darwin Evolution Collection (3314)
Darwin’s symptoms, DSM-IV-TR and
PTSD
Darwin’s symptoms fit the Diagnostic
and Statistical Manual of
Psychological Diseases (DSM IVTR) criteria for PTSD:
1. Traumatic events
2. Emotionally distressing memories
3. Avoidant behaviour
4. Alterations in arousal and
reactivity
5. Chronic illness
PTSD and other diagnoses
PTSD
PTSD
Physical diagnosis
Physical
diagnosis
Differing concepts
Hysteria
Charcot lecturing
on the hysteric,
Blanche Wittman
Pierre-André Brouillet. Clinical lesson at La Salpêtrière Hospital, Paris.
c.1887.(Museé d’Histoire de la Médecine, Paris).
Differing concepts
• War
• Irritable Heart
• Soldier’s heart
• Da Costa’s Syndrome
(American Civil War)
• ‘Nostalgia’ in soldiers
(Dr Johannes Hoffer,
Swiss, 1678)
• ‘Estar roto’ = To be
broken (Spanish)
William Simpson. (1823-1889). Embarkation of the sick at Balaclava.
Crimean War (1853-1856)
Dr James Manby Gully (1808-1883)
Tudor House, Dr Gully’s
water cure establishment – opened 1842
The Regime
Dr Gully’s regime 'was based
on the idea that all
chronic disorders were
caused by a faulty supply
of blood to the viscera
and the application of
cold water to the skin
would return the
circulation to normal and
alleviate the condition.’
Browne, J. ‘Spas and sensibilities: Darwin
at Malvern’. Medical History 1990;34
suppl S10:102-113
Cartoon by Spy. Dr James Gully.
Vanity Fair. (5th August 1876)
1849 Dr Gully’s diagnosis
• Nervous Dyspepsia
• Excessive intellectual
endeavour
• ‘The digestive organs
irritated the brain and
spinal cord and these in
turn irritated the
stomach’
•
Browne, J. ‘Spas and sensibilities:
Darwin at Malvern’. Medical History
1990;34 suppl S10:102-113
1837 – Darwin’s B notebook
on Transmutation of species, p. 36,
‘I think...’ and first drawing of evolutionary tree
The lamp or perspiration bath
I am heated by Spirit lamp
till I stream with
perspiration, & am then
suddenly rubbed violently
with towels dripping with
cold water: have two cold
feet-baths, & wear a wet
compress all day on my
stomach.
Darwin, C.R. (1849) Letter 1236 to
Hooker, J.D., 28 March 1849. Darwin
Correspondence Database,
http://www.darwinproject.ac.uk/entr
y-1236
Priessnetz’s hydrotherapy cure,
Grafenberg, Germany,
Corset Wrap c. 1860.
1865 Spinal Ice Bags
• ‘I have had a shocking
month with much sickness
& have done nothing: I am
now trying, at first with
strong hope, now with weak
hope, Dr. Chapman's icebags along the spine, which
at least is comfortable.’
•
Letter to JD Hooker, June 1st 1865
• ‘Papa had a good day
yesterday in & out & to the
sand walk. No effect from
ice. Certainly no bad effect.’
•
Letter from Emma Darwin to
Henrietta, 1 June 1865
Darwin and electrotherapy
November 1845: he tries ‘passing a
galvanic stream through my insides
from a small-plate battery.’
(Galvanism) ‘I have been unusually
well.’
October 1851: he writes in his Diary
of Health of using ‘electric Chains
attc’ [attached] waist,’ and ‘do [ditto]
neck’. These did nothing for him.
Colp 2008
2 June 1869: Darwin writing to SP
Engleheart: ‘… have you heard any
credible account of good being
derived in dyspepsia & nervous
weakness from “Pulvermachers
Volta-Electric Chain bands”… [is it]
quackery & lies, or wd it be worth
trying as an experiment?’ He did not
follow this up.
Pulvermacher’s galvano-electric
chain belt
Pulvermacher’s chain charged
by being drawn through vinegar
Doctors’ prescriptions
A visit by Dr William Jenner 20
March 1864
‘No organic mischief’. He would
‘some day’ get over his vomiting
His regimen:
• Reduced intake fluids
• Combinations of antacids – chalk,
lime water, carbonate of
magnesia, carbonate of ammonia
• Colchicum
• Podophyllin
• Taraxacum
• Bismuth
15 May: ‘I have now been more than
a month without sickness’
Sir William Jenner (1815-1898)
c. 1860
Medicine chest of Sir James Reid (1849-1923),
personal physician to Queen Victoria
Possible mechanisms for Darwin’s
temporary improvements
• The placebo effect
• The benefits of exercise
on depression in the
Water Cure
• An adrenaline high from
immersions in cold water
• Massage in the guise of
towel rubbing
• A break from his
intellectual labours
Darwin’s illness in his social context
•
•
•
•
•
•
He was persistent in looking for cures
He was prepared to try cures that
were unpleasant, time-consuming,
unorthodox and expensive in his
search for health
He followed health fashions such as
the Water Cure and galvanism
His treatments were those available
to a well-off Victorian gentleman
His PTSD was an exemplar of what
was happening to thousands of
others in England at the time
His was a continuing struggle
between his personal emotions and
his scientific studies: the contrast
between the boy with depression
and the study of the facial muscles of
emotion.
A boy with depression
from CD ‘The Expression
of the Emotions
in Man and Animals.’
The muscles of the face,
from the same book
19th April 1882 – Darwin’s death
My thanks to the Society of Apothecaries: this talk was based on a dissertation written
for the DHMSA exam
_________________________________________________________
FURTHER READING
•
Browne, J. ‘Spas and sensibilities: Darwin at Malvern.’ Medical History 1990;34 suppl. S10:
102-113
•
Colp R Jr. Darwin’s Illness. Gainesville, Fla.: University Press of Florida. 2008.
•
Desmond A, Moore J. Darwin. London: Michael Joseph. 1991
•
Heyse-Moore, LH. ‘Darwin’s illnesses: the role of post-traumatic stress disorder.’ Journal
Medical Biography. In press.
•
Levine, P. Waking the Tiger: Healing Trauma. Berkeley, California: North Atlantic Books. 1997
•
The Darwin Correspondence Project (his correspondence available on-line):
http://www.darwinproject.ac.uk/