Medical science of the time was neither able to diagnose the cause of his problems nor to help much with the symptoms, writes WILLIAM REVILLE
THE BEST-KNOWN name in biology is Charles Darwin (1809-1882), forever associated with the central unifying biological theory of evolution through natural selection. Darwin was ill all his adult life and was greatly preoccupied with the various florid symptoms of his condition.
Many people have speculated on the exact nature of this illness. The latest addition to the literature on this subject comes from Fergus Shanahan, professor of medicine and director of the Alimentary Pharmabiotic Center at UCC. In his paper in the American Journal of Gastroenterology (Vol 107, pp161-164, Feb 2012), Shanahan uses his specialist knowledge in gastroenterology to firmly diagnose the nature of Darwin’s illness.
Charles Darwin was the son of Robert Darwin, a wealthy Shropshire physician and financier. As a youth he enjoyed the country pursuits of riding and hunting, but was always of a somewhat nervous disposition. He showed little early focused career ambition, so much so that his father declared him to be an idler who would amount to nothing.
Darwin went to Edinburgh University in 1825 to study medicine but felt sickened by the crude surgical techniques of the day. His real passion was for natural history. He went to Cambridge University in 1828 to begin studies that would lead to a career as a clergyman. He graduated with a BA, all the while keeping up his interest in natural history. Gaining a reputation in biology, he was hired as naturalist to accompany Captain Robert FitzRoy on the scientific survey voyage of HMS Beagle (1831-1836).
Darwin suffered chest pains and heart palpitations before the Beagle set sail and was affected by sea sickness throughout the voyage. He was afflicted with several fevers during the voyage including an attack by the “great black bug of the Pampas Benchuca”, associated with transmission of the tropical parasitic Chagas disease.
Darwin returned from his voyage in October 1836 and spent the rest of his life formulating and strengthening the great theory of evolution through natural selection. And, for more than 40 years, he suffered greatly from illnesses accompanied by a multitude of symptoms including vomiting, cramps, flatulence, bloating, dizziness, vertigo, headaches, fatigue, palpitations, crying, anxiety, insomnia, sensations of impending death, fainting, depression and tinnitus.
Darwin consulted more than 20 doctors but medical science of the time was neither able to diagnose the cause of his problems nor to help with the symptoms. He did get some relief from alternative medicine treatments, in particular from water treatment combined with homeopathy. Darwin was an enthusiast for water treatment, a course of alternative “medical” treatment by hydrotherapy which persists to this day.
Many diagnoses have been proposed for Darwin’s illness. Organic diagnoses include arsenic poisoning, Crohn’s disease, allergy, lupus, Ménière disease, and Chagas disease, while psychosocial diagnoses include psychoneurosis, hypochondria, agoraphobia, panic disorder and stress.
Shanahan discusses these various diagnoses, but, drawing on his specialist knowledge of modern gastroenterology, he identifies Darwin’s illness as “dysfunctional bowel syndrome in the spectrum of functional dyspepsia and irritable bowel syndrome (IBS)”. Darwin’s many non-gastrointestinal problems are consistent with “comorbid extra-intestinal somatization, a frequent accompaniment of IBS”. Dyspepsia means indigestion/upset stomach and comorbid extra-intestinal somatisation means physical ailments beyond the intestines that tend to cluster with IBS.
Shanahan points out that Darwin’s symptoms of functional dyspepsia-IBS are familiar to any modern gastroenterologist and are characterised by onset in early adulthood, absence of sinister symptoms, eg weight loss, unpredictable bowels after meals impacting on lifestyle, exacerbation with psychological distress or marked placebo responsiveness.
Darwin acknowledged that his medical problems helped him in his scientific work, allowing him an excuse to avoid social distractions and to concentrate on thinking deeply about science. “Even ill-health, though it has annihilated several years of my life, has saved me from the distractions of society and amusement,” he said.
William Reville is an emeritus professor of biochemistry and public awareness of science officer at UCC, understandingscience.ucc.ie