Darwin's Illness

16. Theories of Darwin’s Doctors, and of Darwin

16 Theories of Darwin’s Doctors, and of Darwin There is no record of how Dr. Robert Darwin diagnosed his son’s illness. Some doctors were “puzzled” by the illness.1 Others viewed it as a form of dyspepsia: Dr. Gully diagnosed it as “nervous dyspepsia.”2 “Dr. Lane described it as “dyspepsia of an aggravated character.”3 George Busk thought it was “waterbrash,”4 whereas the British Medical Journal reported that Darwin had suffered from “catarrhal dyspepsia.”5 Dr. Holland concluded that Darwin was suffering from a form of gout without joint inflammation, “nearer to suppressed gout.”6 Drs. Brinton and Jenner also suspected “suppressed gout,”7 and Dr. Clark found manifestations of a “gouty” state.8 For several doctors these two diagnoses were related. Dr. Holland believed that gout was “dependent on a specific material agent, capable . . . of affecting . . . almost every part or function of the body.” He further proposed that there was an “undoubted connection between dyspeptic disorders and the irregular forms of the gouty constitution; a constitution sufficiently close and familiar to observation to justify the belief of relation to some common cause; acting under different modifications from age, sex and other temperament of body; as well as from variations, it may be, in the quality proportion of the morbid matter itself.”9 Some physicians held that “flatulency . . . generally ushers in an attack of gout.”10 Dr. Alfred Baring Garrod, a leading authority on gout, wrote: “Those varieties of dyspepsia which lead to the excessive formation of uric acids in the system, tend powerfully to the production of gout,” “that in gouty cases . . . an excess of uric acid circulating in the blood may itself give rise to a secondary form of dyspepsia, and cause many of the premonitory symptoms referable to the digestive organs, so commonly met with in gouty subjects,” and that severe and prolonged study and mental anxiety could cause gout.11 128 / Chapter 16 Dr. Garrod had shown that in gout the blood uric acid level is elevated, and in1854heintroducedthefollowing“threadtest”foruricacid.Bloodwasdrawn from the patient—since there was a “natural repugnance” to drawing blood, it was sometimes possible to make a blister and draw off its serum—which was then acidified and evaporated; if uric acid was present, crystals formed which adhered to a fine thread. Garrod held that if these crystals did not form, and the results of the “thread test” were negative, the diagnosis of gout was excluded.12 This “thread test,” one of the earliest of bedside diagnostic tests, soon became widely used.13 It is not known whether any of Darwin’s doctors applied the thread test to his blood. However, in September 1873, Dr. Andrew Clark wrote him that his urine had uric acid and therefore he was “gouty.” Darwin came to believe that two causes for his illness were the ill effects of the Beagle cruise and heredity. In the years 1857–60, when he was a patient at Moor Park, he told Dr. Lane that he “supposed” the Beagle seasickness caused his dyspepsia.14 In 1864, he told his brother Erasmus that he did “not believe” his seasickness “was the cause of my subsequent ill health,” and he stated the same belief to his son Francis.15 In 1871 he said to a visitor that “some of his friends” thought that his illness “might be attributed to long-continued seasickness on his voyage years ago.” He then abruptly changed the subject.16 Francis, however, records that his father was “sometimes inclined to think that the breaking up of his health was to some extent due” to his September–November 1834 episode of Chilean fever .17 Darwin’s most frequently stated opinion about the origins of his illness was that it was a form of gout that he had inherited. In 1868, in The Variation of Animals and Plants under Domestication, he published examples of the inheritance of illness, including gout: “With gout, fifty percent of the cases observed in hospital practice are according to Dr. Garrod, inherited, and a greater percentage in private practice.” Near the end of the Variation, he published his theory of pangenesis: propounding that the body cells give off gemmules that become part of the reproductive cells and that “man carries in his constitution the seeds of an inherited disease.”18 He applied his ideas about the inheritance of illness to himself in several ways. He observed that his family was gouty.19 He believed that his father had had gout...