Poor Darwin; one has to feel sorry for him, not just because he was ill so much of the time, but also because the world now knows so much about his heart palpitations, the color of his urine, and his bowel movements! But the man himself seems to have relished all the details of his symptoms, set out for many years in a diary and in lists sent to an unending supply of doctors and quacks. He is famous for taking "cures" at expensive spas, such as the one run by Dr James Gully (principally involving cold baths and a strict diet). It is remarkable that such a perennially sick man got such a prodigious amount of work done.
Thirty-two years ago, Ralph Colp Jr, a psychiatrist, gave us a comprehensive view of Darwin's illnesses and some best guesses as to their causes in his influential book To be an Invalid (Chicago: University of Chicago Press, 1977). Now he has revised that work in the light of the many new ideas that have been suggested about what ailed the great man. In this new edition Colp has carefully transcribed Darwin's "Diary of Health" of 1849 to 1855, but sadly the details of contemporary nostrums that enlivened the first edition have been removed.
Just how ill was Darwin? Colp makes it clear that he was unwell, on and off, for his whole life. The contradictory patterns of Darwin's illnesses started in his youth. He was both a strong athletic youngster and quite psychologically tender. Evidence suggests that he was deeply affected by the death of his mother, when he was only eight. He stammered and always had a weak stomach (especially at breakfast). As a teenager he began to suffer bad eczema on his face (especially the lips) and hands and this was always associated with anxiety and stress.
At Cambridge he seems to have suffered periodic depression. Just before the Beagle voyage (1831–1836), while miserably delayed in Plymouth, he developed palpitations and, it is thought, paresthesia in which his finger tips became numb. During the voyage itself, he suffered surprisingly little from the sorts of stomach upsets and fevers that one might expect from someone exploring fearlessly on horseback across South America. But on at least two occasions he was seriously laid up for weeks at a time.
After the Beagle voyage, while he was working feverishly to establish himself as a writer and geologist in London, he found that hard mental work led immediately to severe headaches, the ever-present eczema, palpitations, dyspepsia, and exhaustion. He was already on the way to becoming an invalid. In early to mid-1838 he added a whole new phase of symptoms involving much vomiting, "stomach" pain, extreme flatulence (belching), an acid stomach, night waking, an ulcerated tongue in the morning, and more severe eczema of the face and hands. At more than six feet and 148 pounds, he was marginally underweight. Readers may be surprised at some of his more obviously psychological symptoms, which included hysterical crying, "rocking," feeling that his stomach was "cold," seeing black dots, feeling a sensation of "walking on air," "dying sensations," ringing of the ears, and exhaustion and self-loathing. Interestingly he did not suffer much from fever or diarrhea; his intestinal difficulties were centered on the esophagus, stomach, and duodenum. One is almost shocked by the extent and duration of the agonies that Colp has documented.
Many doctors were consulted and most cures worked for a little while. One such was dilute muriatic (hydrochloric) acid — an odd prescription for an acid stomach. Other doctors prescribed bismuth and calcium. He always had a craving, verging on an addiction, for sugar, and moving to what we would term a "better" diet usually helped, as did sitting upright, exercise, and a little wine.
This is a book for anyone interested in Darwin's complex life and the nineteenth century, with special interest for historians of science and medicine and for social historians. Every reader will naturally turn diagnostician and one's first instinct is to visit upon Darwin those conditions of which one has first hand experience. Over the years many theories have been proposed — from repressed homosexuality (!) to lactose intolerance and Crohn's disease. A long-standing favorite of Colp's is Chagas's disease, although to make the case for Chagas's, he has to invoke both an early latent phase and then a kind of secondary version later.
Darwin's obsessive preoccupation with health may in fact give us a clue to the causes of his symptoms. All the evidence points to a direct causal link between stress and his varied symptoms. The 1838 deterioration in his health coincided with his marriage and almost simultaneous recognition of the Malthusian principle that set the seal on his theory of natural selection — the secret ("like confessing a murder") that he was keeping from his colleagues and the extremely religious Emma. His health improved in the 1850s when he was engrossed in studies of barnacles and again in his last few years.
The range of Darwin's symptoms suggests, at the least, extreme hypochondria and a kind of chronic anxiety syndrome, coupled with — and perhaps causing — a variety of upper alimentary disturbances. But the story of Darwin's health is like a mystery novel from which the last chapter has been deleted. Short of exhuming his body from Westminster Abbey, we probably will never fully know what ailed him. Meanwhile, except for the fact that its index is truly abysmal, this is a really valuable book. Everyone seeking to understand Darwin should read it and choose among the rival explanations of what brought him so low while he was achieving such greatness.