248 HISTORY OF MEDICINE Postgrad Med J: first published as 10.1136/pgmj.2004.025569 on 5 April 2005. Downloaded from Darwin’s illness revealed Anthony K Campbell, Stephanie B Matthews ............................................................................................................................... Postgrad Med J 2005;81:248–251. doi: 10.1136/pgmj.2004.025569 After returning from the Beagle in 1836, Charles Darwin diagnosis defied the 20 doctors, including his father, who examined him. Darwin’s symptoms suffered for over 40 years from long bouts of vomiting, gut match exactly those we have described for systemic pain, headaches, severe tiredness, skin problems, and lactose intolerance.17 18 He only got better when, by depression. Twenty doctors failed to treat him. Many books chance, he reduced his milk and cream intake. and papers have explained Darwin’s mystery illness as DARWIN’S ILLNESS organic or psychosomatic, including arsenic poisoning, Charles Darwin recorded his symptoms and his Chagas’ disease, multiple allergy, hypochondria, or tribulations in his health diary: bereavement syndrome. None stand up to full scrutiny. His N Chronic fatigue and exhaustion medical history shows he had an organic problem, N Severe gastrointestinal problems, including exacerbated by depression. Here we show that all pain Darwin’s symptoms match systemic lactose intolerance. N Nausea Vomiting and gut problems showed up two to three hours N Frequent vomiting N A swimming head after a meal, the time it takes for lactose to reach the large N Severe headaches intestine. His family history shows a major inherited N Trembling component, as with genetically predisposed hypolactasia. N Insomnia Darwin only got better when, by chance, he stopped taking N Joint pain milk and cream. Darwin’s illness highlights something else N Rashes and eczema he missed—the importance of lactose in mammalian and N Mouth ulcers human evolution. N Boils Tooth and gum problems ........................................................................... N N Heart palpitations have had a bad spell. Vomiting every day N Poor resistance to infections for eleven days, and some days after every N Depression. http://pmj.bmj.com/ meal.’’ Thus wrote Charles Darwin, aged 54, ‘‘I 1 on 5 December 1863 to his friend Hooker. For His son Francis Darwin (1848–1925) wrote; 40 years, Darwin suffered from a range of symp- ‘‘For nearly 40 years he never knew one day of the toms that devastated him for weeks on end. health of ordinary men, and his life was one long Explanations have been organic or psychosomatic struggle against the weariness of strain and (table 1).1–26 None have produced a satisfactory sickness’’.227 To see how this ill health affected answer. On 10 December 1831, aged 22, Darwin Darwin you simply have to read the many letters was at Plymouth awaiting better weather for the to friends and family complaining of how unwell on September 28, 2021 by guest. Protected copyright. Beagle to depart. To his horror he suffered a bout of he felt all the time, and how it was slowing down the illness that was to plague him for the rest of his his work.127 One year after returning from the life (Darwin C R, Diary of Health, unpublished; Beagle voyage stress had an important effect on his Barlow et al2). He had chest pain and heart overall wellbeing,15 16 and within another year he palpitations, but told no one at the time, fearing had given up going to parties. Some authors29 have it might prevent him taking his trip of a lifetime. hinted that he didn’t turn up to events because he On the Beagle he seems to have been essentially was afraid to meet his critics face to face. But his healthy, apart from one bad bout of fever and letters1 show that it was his illness that stopped See end of article for frequent sea sickness. Returning home in 1836, he from going to the famous Oxford debate in 1860, authors’ affiliations married in 1837 and set up house with Emma. On where Bishop Wilberforce (1805–1873) was con- ....................... 20 September 1837, the problem struck again— fronted so successfully by T H Huxley (1825– Correspondence to: heart palpitations. For the rest of his life he was to 1895). However, the real reason was his contin- Professor A Campbell, be plagued by ill health. Some bouts were so bad uous ill health confining him to Down House. His Department of Medical that, to his great frustration, he had to stop work friends had to come there to see him. Biochemistry and for weeks. He recorded his symptoms in many Immunology, Wales Attempts to unravel what might have been College of Medicine, letters and in his Diary of Health, which he wrote wrong with Charles Darwin have been confused Cardiff University, Heath between 1 July 1849 and 16 January 1855. His by several unanswered questions: Park, Cardiff CF14 4XN, worst problems were recurrent nausea, retching UK; [email protected] and vomiting, gut pain, flatulence, headaches, and N Did Darwin only really suffer after the Beagle trip, or had he suffered since childhood? Submitted 15 June 2004 a swimming head. He also suffered intermittently Accepted 14 July 2004 from eczema, particularly on the face, boils, and N Is there any evidence of an inherited problem ....................... continual fatigue. No wonder he got depressed. The in the Darwin/Wedgwood dynasties? This has www.postgradmedj.com Darwin’s illness revealed 249 Postgrad Med J: first published as 10.1136/pgmj.2004.025569 on 5 April 2005. Downloaded from often been ignored because of lack of analysis of family Table 1 Proposed causes of Darwin’s disease records. N How much did his medical history have an impact on his Causal type Specific cause Reference health? In particular did he have any severe illnesses as a Organic Heart disease Darwin himself (1831–1882)12 child that could have left him with long term problems? and Diary of Health Nervous indigestion Obituary (1882)2 N Could he have poisoned himself with the chemicals used 4 Chronic from sea Obituary (1882) in his scientific work? sickness N When and why did his illness apparently abate towards Chronic neurasthenia Johnston, 19015 6 the end of his life? This is important as there is no obvious Chronic eye strain Gould, 1903 Aftermath of Chilean Leonard Huxley, 1927, see reason for this if his problems were psychosomatic. fever Colp7 Pyorrhoea Leonard Darwin, 1927, see Several articles have claimed that Darwin (1809–1882) had Colp7 excellent health at least until 1836, after the Beagle. Yet Brucellosis Simpson, 19588 Chagas’ disease Adler, 19599 Darwin clearly described stomach pain, skin problems, 10 12 Metabolic disease Stetten, 1959 mouth ulcers, and heart palpitations before this. He had Acute intermittent With, 1960, see King-Hele11 scarlet fever at the age of 9, and notes excessive fatigue as porphyria early as 1829 at the age of 20. He had bouts of mouth sores Diaphragmatic hernia Kohn, 196312 13 and eczema while at Cambridge. And there was the heart Narcolepsy (diabetes) Roberts, 1966 Arsenic poisoning Winslow, 197114 palpitation incident that we described earlier as he waited to Pigeon allergy Gruber and Barrett, 1974, see join the Beagle at Plymouth. This, with the family his- Colp7 tory,2 15 16 27–30 supports the hypothesis that the major cause of Peptic ulcer See Colp p1307 7 his symptoms, which became so bad in middle age, was both Duodenal ulcer See Colp p130 Appendicitis see Colp p1307 organic and hereditary. His seasickness on the Beagle is a red 7 Smouldering hepatitis See Colp p130 herring. He did have a major health crisis in Valparaiso in Cholecystitis See Colp p1307 October 1834, leaving him ill in bed for more than a month. Amoeba infection See Colp7 Several authors have concluded that this was a genuine Allergy Smith, 1990, 199215 16 17 18 organic illness, probably typhoid. Afterwards he complained Systemic lactose Campbell and Matthews, intolerance of tiredness, and that small skin lesions tended to go septic. Psycosomatic But despite these health problems, he did not suffer on the 1st pscychoanalytical Kemf, 191819 Beagle from the illness he complained of so much in later life. theory Hypochondria Hubble, 194320 Although his illustrious grandfather Erasmus Darwin 20 Psychoneurosis Hubble, 1943 (1731–1802) was a pioneer of immunisation, Charles was Chronic depression Alvarez, 195921 not immunised as we are today and was thus exposed to the Psychosomatic Woodruff 196522 usual set of 19th century childhood illnesses, including Bereavement syndrome Bolby, 1965, 199023 24 7 scarlet fever. He took a wide range of medications in an Neurosis Colp, 1977 Mixed psychosomatic Colp, 19777 attempt to find a cure to his major problem. Darwin records Anxiety state Bernstein, 198225 taking several ‘‘poisons’’ as therapy throughout his life, Panic syndrome Barloon and Noyes, 199726 including arsenic, bismuth, amyl nitrite, morphine, quinine, and calomel, which contains mercury. Many of these are http://pmj.bmj.com/ known to have toxic side effects. Although the symptoms of arsenic poisoning bear some resemblance to Darwin’s,14 they Any infection of the small intestine will cause hypolactasia, are not close enough. Furthermore, Darwin refused arsenic as and thus lactose intolerance. The problem with Chagas’ a result of his father’s advice. Scientists 150 years ago did not disease as an explanation for all Darwin’s symptoms (table 2) have to fill in COSHH forms. Darwin used many toxic is there is no record of Darwin on the Beagle having the chemicals in his study for fixing and preserving his speci- expected initial fever and other early symptoms of Chagas’ mens. These would have included phenol, formaldehyde, disease.29 Nor does the full list of Darwin’s symptoms match various alcohols, and stains.