He consulted with more than 20 doctors, but with the medical science of the time the cause remained undiagnosed. He tried all available treatments, but at best they had only temporary success. More recently, there has been much speculation as to the nature of his illness.
On 10 December 1831, as he waited in Plymouth for the voyage on HMS Beagle to begin, he suffered from chest pain and heart palpitations, but told no one at the time in case it stopped him from going on the survey expedition. During the voyage he suffered badly from sea-sickness during the eighteen months he was at sea, but he spent much of the 3 years 3 months he was on land in strenuous exploration. In Argentina at the start of October 1833 he collapsed with a fever. He spent two days in bed, then memories of a young shipmate who had died of the fever persuaded him to take a boat down river to Buenos Aires, lying ill in his cabin till the fever passed. On 20 September 1834 while returning from a horseback expedition in the Andes mountains, he fell ill, and spent the month of October in bed in Valparaiso. In his journal for 25 March 1835, while to the east of the Andes near Mendoza, he noted "an attack (for it deserves no less a name) of the Benchuca, a species of Reduvius, the great black bug of the Pampas" which is associated with Chagas' disease.
After the voyage ended on 2 October 1836 he quickly established himself as an eminent geologist, at the same time secretly beginning speculations on transmutation as he conceived of his theory. On 20 September 1837 he suffered "an uncomfortable palpitation of the heart", and as "strongly" advised by his doctors, left for a month of recuperation in the countryside. That October, he wrote "Of late anything which flurries me completely knocks me up afterwards, and brings on a violent palpitation of the heart. In the spring of 1838 he was overworked, worried and suffering stomach upsets and headaches which caused him to be unable to work for days on end. These intensified and heart troubles returned, so in June he went "geologising" in Scotland and felt fully recuperated. Later that year, however, bouts of illness returned - a pattern which would continue. He married Emma Wedgwood on 29 January 1839, and in December of that year as Emma's first pregnancy progressed, he fell ill and accomplished little during the following year.
For over forty years Darwin suffered intermittently from various combinations of symptoms such as malaise, vertigo, dizziness, muscle spasms and tremors, vomiting, cramps and colics, bloating and nocturnal intestinal gas, headaches, alterations of vision, severe tiredness /nervous exhaustion, dyspnea, skin problems such as blisters all over the scalp and eczema, crying, anxiety, sensation of impending death and loss of consciousness, fainting, tachycardia, insomnia, tinnitus, and depression.
In September his sickness returned during the excitement of a British Association for the Advancement of Science meeting, and Darwin made a day visit to Malvern, then recuperated at home. In June 1850 after losing time to illness (without vomiting) he spent a week at Malvern. Later that year he wrote to Fox about the credulity of his "beloved Dr Gully" who, when his daughter was ill, had her treated her with a clairvoyant girl to report on internal changes, a mesmerist to put her to sleep, John Chapman as homœopathist and himself as Hydropathist, after which Gully's daughter recovered. Darwin explained to Fox his wrathful scepticism about clairvoyance and, worse, homeopathy, thinking the infinitesimal doses were against all common sense and should be compared against the effects of no treatment at all. Gully had pestered Darwin to subject himself to clairvoyance, and when he saw the clairvoyante he tried to test her by asking her to read the number on a banknote he had in an envelope, but she scornfully said this was something her maidservant did, and proceeded to diagnose horrors in Darwin's insides, a tale he recounted for years afterwards. When Darwin's own young daughter Annie had persistent indigestion he confidently took her to Gully on 24 march 1851, and after a week left her there to take the cure, but a fortnight later was recalled by Dr Gully as Annie had bilious fever. Dr. Gully was attentive and repeatedly reassured them that she was recovering, but after a series of crises Annie died on 23 April. Darwin was heartbroken at this tragic loss, but surprisingly stayed well in the aftermath, busy with organising the funeral arrangements.
Darwin kept records of the effects of the continuing water treatment at home, and in 1852 stopped the regime, having found that it was of some help with relaxation but overall had no significant effect, indicating that it served only to decrease his psychosomatic symptomatology.
With the memories of Annie's death, Darwin did not want to return to Malvern. In 1856 he began writing for publication of his theory and he pressed on, overworking, until by March 1857 illness was cutting his working day "ridiculously short". He found a new hydrotherapist, Dr. Edward Wickstead Lane, whose Moor Park hydropathic establishment near Farnham in Surrey, was only 40 miles from Darwin's home. His condition was much as when Darwin had first seen Gully, and Dr. Lane later wrote "I cannot recall any [case] where the pain was as poignant as his. When the worst attacks were on, he seemed crushed with agony." Darwin arrived on 22 April, and wrote to Fox that "it is really quite astonishing & utterly unaccountable the good this one week has done me", deciding to stay on to 5 May. He enjoyed the more relaxed regime which did not include clairvoyance, mesmerism or homeopathy, as Lane did "not believe in all the rubbish which Dr G. does." Darwin became a complete convert, "well convinced that the only thing for Chronic cases is the water-cure", and wrote "I really think I shall make a point of coming here for a fortnight occasionally, as the country is very pleasant for walking." He told Hooker he had "already received an amount of good, which is quite incredible to myself & quite unaccountable.— I can walk & eat like a hearty Christian; & even my nights are good.— I cannot in the least understand how hydropathy can act as it certainly does on me. It dulls one's brain splendidly, I have not thought about a single species of any kind, since leaving home." then contradicted himself by asking about alpine species.
He returned to Moor Park from 16–29 June and 5-12 November 1857, and from 20 April to 3 May 1858, but this retreat was unavailable when he was shocked by receipt of Wallace's paper on 18 June, as Dr. Lane was put on trial accused of adultery with a lady patient. Darwin was able to resume treatment at Moor Park from 25–31 October 1858, as he struggled on to write On the Origin of Species despite repeated health problems. He was able to keep writing thanks to visits to the spa on 5–18 February, 21–28 May and 19–26 July 1859. With the proofs of book returned to the printers he was worn out, and went with his family to a spa at Wells Terrace, Ilkley, on 2 October, that was operated by Dr Edmund Smith, a surgeon and hydropathic doctor. Reading the first adverse reviews there, his health worsened with a sprained ankle followed by a swollen leg and face, boils and a rash. He had an "odious time", and wrote of Smith that "he constantly gives me impression, as if he cared very much for the Fee & very little for the patient," but towards the end of the stay his health problems cleared up, and he left on 7 December feeling much better. As arguments continued, Darwin had more stomach upsets and on 28 June 1860, two days before the famous 1860 Oxford evolution debate, he fled to Lane's new hydropathic establishment at Sudbrooke Park, Petersham, near Richmond in Surrey, and recuperated as well as reading reports of the debate.
Darwin avoided further hydropathy, perhaps recalling his time at Ilkley, and Lane left the business for a while after selling Sudbrooke Park. In 1863 Darwin's illness worsened seriously, and Emma Darwin persuaded her husband to return to Malvern. His cousin Fox had earlier told him that Gully had suffered a mental breakdown and was unavailable. They arrived on 2 September, but Darwin felt that he was being fobbed off with the supervising physician, Dr. Ayerst. Emma arranged for Dr. Gully to attend and endorse Ayerst's treatment, but by then Darwin's eczema was too raw to bear any water. Darwin had a complete breakdown, and on 13 October left the spa worse than when he'd arrived. His ill health was the worst he had ever experienced, and continued until the start of 1866.
In his autobiography of 1876, Darwin wrote of his illness, emphasising that it was brought on by 'excitement':
Barloon and Noyes report that as a young man, Darwin had "episodes of abdominal distress, especially in stressful situations". He had a "premorbid vulnerability" which in his youth was referred to as "sensitivity to stress of criticism in his youth." They contend that "variable intensity of symptoms and chronic, prolonged course without physical deterioration also indicate that his illness was psychiatric." Panic disorder usually appears in the teens or in early adulthood with an association with potentially stressful life transitions. The histories of panic disorder patients often include some type of separation from a person who is emotionally important to them, which may be significant as Darwin's mother died in 1817 when he was eight, though apparently Darwin had a happy childhood overall and was encouraged by his siblings. Bowlby suggested that separation anxiety may help cause the development panic disorder in adulthood and that agoraphobic patients frequently describe parents as dominant, controlling, critical, frightening, rejecting, or overprotective, which matches (disputed) descriptions of Darwin's father as tyrannical (see below).
A study by Chambless and Mason says that regardless of gender, the less masculine in trait a person afflicted with panic disorder is, the more likely they are to use avoidance (social withdrawal) as a coping mechanism. Individuals who have a more masculine traits often turn to external coping strategies (for example, alcohol). Dr. Bean wrote that while Darwin had great confidence, at the same time he was neurotic, became nervous when his routine was altered, and was upset by a holiday, trip, or unexpected visitor.
Colp disputes a diagnosis of agoraphobia, because Darwin dutifully attended 16 meetings of the Council of the Royal Society and was away from home about 2,000 days between 1842 and his death in 1882, but Barloon and Noyes state that Darwin only left home infrequently, usually accompanied by his wife. They cite Darwin declining an invitation; "I have long found it impossible to visit anywhere; the novelty and excitement would annihilate me".
Psychosomatic disease, social withdrawal, and isolation may also be a result of some debilitating organic disease. Hypochondria could be present and represent an exacerbation of organic disease. Darwin described in great length and in extreme clinical detail his suffering in his diaries (he went to the extreme of recording daily the volume and quality of his tinnitus). It is hard to tell whether some of his mostly subjective observations were real or imaginary.
Darwin's autobiography says of his father, "... [he] was a little unjust to me when I was young, but afterwards I am thankful to think that I became a prime favourite with him." Bradbury quotes J. Huxley and H.B.D. Kettlew; "The predisposing cause of any psychoneurosis which Charles Darwin displayed seems to have been the conflict and emotional tension springing from his ambivalent relations with his father ... whom he both revered and subconsciously resented." and John Chancellor's analysis; "... [Darwin's] obsessive desire to work and achieve something was prompted by hatred and resentment of his father, who had called him an idler and good-for-nothing during his youth."
Such psychoanalysis remains controversial, particularly when based only on writings.
Like his mother, Darwin's wife Emma was devoutly Unitarian. His father, speaking from experience, warned Charles before he proposed to Emma that "some women suffered miserably by doubting about the salvation of their husbands, thus making them likewise to suffer." Darwin did tell Emma of his ideas at that stage, and while she was deeply concerned about the danger to his afterlife expressed in the Gospel "If a man abide not in me...they are burned", she married him and remained fully supportive of his work throughout their marriage. She read and helped with his "Essay" setting out his theory in 1844, long before he showed his theory to anyone else. She went through the pages, making notes in the margins pointing out unclear passages and showing where she disagreed. As his illness progressed she nursed him, restraining him from overworking and making him take holiday breaks, always helping him to continue with his work.
Charles Darwin's education at school was Anglican, then after in Edinburgh he joined student societies where his tutors espoused Lamarckian materialism. He liked the thought of becoming a country clergyman, and before studying at the University of Cambridge, "as I did not then in the least doubt the strict and literal truth of every word in the Bible, I soon persuaded myself that our Creed must be fully accepted." The clergyman naturalist professors there who became his lifelong friends fully accepted an ancient earth, but opposed evolutionism which they felt would undermine the social order. He did well at theology and in his finals came 10th out of a pass list of 178. At both universities he saw how evolution was associated with radicals and democrats seeking to overthrow society, and how publicly supporting such ideas could lead to destruction of reputation, loss of position and even imprisonment for blasphemy.
At Cambridge he was convinced by William Paley's writings of design by a Creator, but on the Voyage of the Beagle his findings contradicted Paley's beneficent view. On his return his deepening speculations led to the inception of Darwin's theory, and he increasingly disbelieved in the Bible, gradually becoming what was later termed an agnostic.
Darwin was clearly worried by the implications of his ideas and desperate to avoid distress to his naturalist friends and to his wife. When first telling his friends he wrote "it is like confessing a murder", and his writings at the time of the publication of Darwin's theory suggest emotional turmoil. What is unclear is whether this was anxiety about disgrace and damage to his friends, or about his loss of faith in Christianity, or indeed a rational fear of the harsh treatment he had seen meted out to radicals and proponents of evolutionism.
Arguments for the Chagas hypothesis were mainly his gastric symptoms and some of his nervous signs and symptoms (caused in Chagas by an imbalance of the autonomic nervous system), malaise and fatigue, as well as his ultimate cause of death, which seems to have been chronic cardiac failure (present in ca. 20% of Chagas patients, with cardiomegaly and ventricular tip aneurysm), accompanied by lung edema.
Evidences against the Chagas hypothesis are numerous, however:
Recently, unsuccessful attempts were made to test Darwin's remains for T. cruzi DNA at the Westminster Abbey by using modern PCR techniques, but were met with a refusal by the Abbey's curator. The attempt was the subject of a recent documentary of Discovery Health Channel.
The hypothesis of Ménière's disease has gained some unjustified popularity. A diagnosis of Ménière's disease is based on a series of symptoms, including some which were present in Darwin's case, such as tinnitus, vertigo, dizziness, nausea, motion sickness, vomiting, continual malaise and tiredness. The fact that Darwin did not suffer from hearing loss and that 'fullness' of the ears is never mentioned practically excludes Ménière's disease. The definition of this disease is however not very solid and some form of 'a-typical Ménière's disease' remains a remote possibility. Motion sickness was present throughout his life, and became apparent very early, when he suffered horribly of sea sickness during the whole Beagle voyage. Darwin himself had the opinion that most of his health problems had an origin in his 4-years bout with sea sickness. Later, he could not stand traveling by carriage, and only horse riding would not affect his health. Psychic alteration often accompanies Ménière's and many other chronic diseases. An argument put forward for a diagnosis of Ménière's is that Darwin hunted a lot when he was young and could have damaged his inner ear with the repeated noise of shooting. While it is not unlikely that the noise damaged the inner ear and caused tinnitus, it can not have caused Ménière's disease. While Ménière's disease patients suffer during vertigo attacks from sickness and vomiting, the 'dyspepsia' problems of Darwin have nothing to do with it. One of the diagnoses that he received from his physicians at the time was that of "suppressed gout"; the idea that this was an early name for Ménière's lacks any ground.
Food intolerance and lactase deficiency may also be confused with food allergies. Symptoms include difficulty swallowing and breathing, nausea, vomiting, diarrhea, and abdominal pain. Upon reaching several other organs in the body, allergens can cause hives, eczema, lightheadedness, weakness, hypotension, etc. This has been proposed as the source of Darwin's illness, but the hypothesis is improbable, because, as with lactose intolerance, its temporal and causal relationship with food is easily established, and this was not always the case.
Chronic arsenic poisoning (_chronic_arsenic_poisoning_from_drinking_water) has been considered too. This hypothesis has been advanced by John H. Winslow, who published a book arguing that Darwin took arsenic at low dosages as a remedy and that there was "a very close match" between his symptoms and those of arsenicosis. However, it is highly improbable too, due to the long duration of the illness (40 years), the abruptness of symptoms, the cause of his death, the absence of many symptoms and signs of this kind of poisoning (persistent weight loss and diarrhea, the appearance of dark brown calluses on the palms and the soles of the feet and of skin, known as hyperpigmentation).
Dr. Peter Medawar has supported the diagnosis that Darwin's health problems were part organic, part psychological. Colp concluded that Darwin's illness consisted most probably of panic disorder without agoraphobia, psychosomatic skin disorder, and possibly Chagas disease of the stomach" which he suggested "was first active and then became inactive, permanently injuring the parasympathetic nerves of his stomach and making it more sensitive to sympathetic stimulation and hence more sensitive to the "psychosomatic impact of his anxieties. An organic impairment best explains the lifelong chronicity of many of his abdominal complaints." Thus, the psychological aspects of Darwin's illness might be both a cause and an effect of Darwin's illness. D.A. B. Young noted in a Royal Society journal a 1997 that today the psychogenic view of Darwin's sickness "holds the field" . The proponent of Chagas disease, Dr. Saul Adler, stated that Darwin may have suffered both from Chagas diseas and from "an innate or acquired neurosis".
The issue has become embroiled in the creation-evolution controversy, with allegations that Creationists are drawing attention to interpretation of the illness to damage Darwin's reputation, and counter-allegations that admirers of Darwin refuse to accept faults in the man.