I’ve just gotten back from a terrific trip to the Galapagos Islands, and naturally I’ve been immersed in all things Charles Darwin. That means you’re in for a story about Darwin I suspect you have never heard.
We all know about Darwin’s famous 5 year round-the-world trip on the HMS Beagle, and his subsequent history-changing theory on natural selection and the origin of the species. But there is more to the story.
Darwin had originally gone to medical school at Edinburgh; however, he was a distracted student and didn’t do well. He was much more interested in natural sciences and spent his time learning taxidermy and studying the classification of plants and animals, as well as geology.
Enter the HMS Beagle. During the first voyage of the Beagle, to survey Patagonia and Tierra del Fuego, the captain had committed suicide. For this second voyage, the young new captain, 26-year-old Robert FitzRoy, hoped to avoid the isolation and depression that came with ship command, and was looking for a “gentleman companion” to accompany him on the voyage. Darwin convinced his father and uncle to pay for his passage, over the father’s objections. The two-year voyage turned into five years. Darwin spent most of that time on land investigating geology and making natural history collections, while HMS Beagle surveyed and charted coasts. At intervals during the voyage, his detailed notes and specimens were sent back to Cambridge. Upon Darwin’s return to England, he was popular and eagerly accepted as a gentleman scientist and expert.
But Darwin was never the same after the voyage. He suffered from episodes of heart palpitations, chronic stomach problems, headaches, and trembling. He had intermittent boils. He had cramps, colic, and bloating. He described severe fatigue, nervous exhaustion, fainting and depression. Over time, despite his popularity and frequent speaking engagements, he became more of a recluse. He said, “…ill-health, … has annihilated several years of my life…”. After years of chronic unrelenting illness, he died in 1882 of heart failure.
Let’s investigate this some more, shall we? Even before the voyage, he was somewhat sensitive. He found the blood associated with medical school intolerable. As he was awaiting the departure of the Beagle, he suffered from chest pain and heart palpitations, but kept it to himself, afraid he would be dismissed before the trip even began. After the voyage, he had heart trouble, especially before big speeches, or when he was feeling the pressures of publication. He said, “Of late anything which flurries me completely knocks me up afterwards, and brings on a violent palpitation of the heart.” He often recuperated from these bouts by going hiking alone.
He turned to the then-popular hydrotherapy, with some intermittent benefits. His episodes often worsened before important science meetings, and he would return to the hydrotherapy spa. After three years, he stopped these treatments, convinced they no longer worked. Darwin desperately tried all kinds of medicines, including bismuth compounds and laudanum, and even tried quack therapies, such as electrical stimulation of the abdomen with a shocking belt. For over two decades, his chronic symptoms continued, with exacerbations and remissions, always seemingly worse when he was stressed, and better when he retired to his country house and saw no visitors. This is how Darwin described his problems- “For 25 years extreme spasmodic daily & nightly flatulence: occasional vomiting, on two occasions prolonged during months. Vomiting preceded by shivering, hysterical crying, dying sensations or half-faint. & copious very palid urine. Now vomiting & every paroxys[m] of flatulence preceded by singing of ears, rocking, treading on air & vision. focus & black dots…”
There has been constant curiosity in the medical community about Darwin’s real diagnosis, and the medical literature is replete with scholarly articles trying to diagnose him. In general, for the past one hundred forty years since Darwin’s death, cyclic vomiting, agoraphobia (fear of going outside) and psychosomatic illness have been the most popular culprits. After all, his illnesses were always worse with stress, and Darwin did decline an invitation once, stating, “I have long found it impossible to visit anywhere; the novelty and excitement would annihilate me.” In his autobiography, Darwin explained that his illness was worse with socializing, “Few persons can have lived a more retired life than we have done. Besides short visits to the houses of relations, and occasionally to the seaside or elsewhere, we have gone nowhere. … my health almost always suffered from the excitement, violent shivering and vomiting attacks being thus brought on. I have therefore been compelled for many years to give up all dinner-parties…”
And there the theories stood until 1960. Then, Dr. Saul Adler, an Israeli specialist in Tropical Medicine, proposed that all of Darwin’s chronic symptoms were from longstanding Chagas Disease. This disease, also called American trypanosomiasis, is a tropical parasitic disease caused by Trypanosoma cruzi. Insects known as “kissing bugs” carry the parasite in their feces. When they bite a person, bug feces get mixed into the bite and spread the infection. The parasites multiply in the bloodstream, traveling throughout the body, where they continue to multiply. Over many years, these cycles of parasite multiplication lead to permanent organ damage. Chagas Disease is endemic in Mexico, Central and South America, infecting millions of people, and causing over 9,000 deaths/year. In the acute stage, starting one to two weeks after an insect bite, symptoms can include fever, malaise, headache and liver and spleen enlargement. Typically, the acute phase lasts 4-8 weeks and resolves. Without treatment, 30-40% of infected people develop slowly progressive, chronic heart and digestive system dysfunction over many years. The most common symptoms of chronic Chagas Disease include heart palpitations, fainting, enlarged heart leading to heart failure, acid reflux, enlarged colon, chronic constipation and trouble swallowing.
Although this disease has been described for hundreds of years, it was not formally described (by Dr. Carlos Chagas) until 1909, too late for Darwin. Now there are rapid blood tests to diagnose Chagas Disease, and there are effective anti-parasitic drugs for treatment of the early stage of illness.
But back to Darwin. Does this theory hold water? In 1834, while in Chile, he was sick in bed for a month with a fever. This could have been Chagas (or any of a host of other things.) Darwin noted in his journal for 1835, while in Argentina, he was bitten by the “great black bug of the Pampas” called the Benchuca, commonly known as the kissing bug. So, during the three years he spent exploring in South America, he had plenty of opportunity to be infected.
What about his symptoms? His illnesses in Chile and Argentina could be consistent with Chagas. And the slow progression of heart palpitations and intestinal symptoms over the ensuing years also fit with Chagas. Slowly developing heart failure could have caused intermittent palpitations and waxing and waning fatigue and weakness. Intestinal dysfunction could explain his gassiness, cramps, dyspepsia, and chronic vomiting. Additionally, H pylori, the bacteria that is associated with gastric ulcer disease, is found more commonly in people with Chagas Disease; this could be another explanation for Darwin’s constant dyspepsia. It sounds compelling, doesn’t it? I’m convinced!
There have been many proposals to exhume Darwin’s remains, in order to diagnose his lifelong illness. English law only permits exhumations under suspicion of murder, so we are never going to have proof of his cause of death.
So, Darwin, previously thought to be an emotional, depressed, psychosomatic recluse for most of his life, probably was suffering from a lifelong tropical disease, an unwelcome remnant of his adventurous voyage around the world on HMS Beagle.