Darwin's Illness

31. The Possibility of Crohn’s Disease

31 The Possibility of Crohn’s Disease In 2007, two Chilean physicians, Fernando Orrego and Carlos Quintana, published an article criticizing all previous diagnoses of Darwin’s illness, including my own of Chagas’ disease. They argued that the illness was Crohn’s disease, which is an inflammatory gastrointestinal disease, located mainly in the upper small intestine and manifesting symptoms of abdominal pain, diarrhea, and fatigue. In their opinion, the diagnosis of Chagas’ disease can be “easily discarded” because Darwin did not show the acute symptoms of early Chagas’ and its later chronic symptoms of myorcarditis, megaesophagus, and megacolon. I think this is an opinion that much too easily ignores the possibility that Darwin could have had Chagas’ of the stomach and small intestine that became inactive . I have elaborated on this possibility in this book and mentioned it in my essays, Colp 1998 (which Orrego and Quintana refer to) and Colp 2000.1 I believe that the case for Crohn’s disease frequently consists of questionable connections between contentions advanced by Orrego and Quintana and the evidences they give to support these contentions. They suggest that when Darwin had his severe 1834 fever in Chile, this led to a bacterial infection of his small intestine, which was the beginning of an “inductive phase” of Crohn’s disease, which would later result in clinical signs of the disease. They then state that when the Chilean fever was treated with calomel , a medicine sometimes used as a purgative, this was evidence that Darwin did not have colitis and that his infection was confined to the upper intestine.2 However, all that is known about Darwin’s clinical symptoms is his later recollection that during the fever “every secretion of the body was affected.” When he described these symptoms to his father, Dr. Darwin “could make no guess as to the nature of the disease.”3 Since every secretion of his body was affected by The Possibility of Crohn’s Disease / 177 his fever, it does not seem likely that his use of calomel, one of the most widely used medicines in all kinds of fevers, indicated that he did not have colitis. Orrego and Quintana write that by September 1839, almost three years after Darwin’s return to England from the Beagle, he had the symptoms of the illness that would afflict him for the rest of his life.4 This is not true. He did not have two of his major symptoms—flatulence and vomiting—until late December 1839 and early January 1840.5 In giving a history of Darwin’s symptoms of flatulence and vomiting, Orrego and Quintana are often vague as to when these symptoms have a specific relation to Crohn’s disease (vomiting is not a frequent symptom of Crohn’s) and when they result from overwork, prolonged conversation, and other mental stresses Darwin was under, or other causes. They write that, although Darwin’s “evolutionary ideas and the mental conflicts derived from them did influence his disease, a causal relationship is unwarranted.” As evidence for this, they cite Darwin’s eight years of work on barnacles, “a non-conflicting subject,” when he lost two years to illness. This ignores the fact that during those eight years Darwin continued to work on his evolutionary ideas and to experience mental conflicts over them. As he wrote in his autobiography, after July 1837 he “never ceased working” on the subject of evolution,” and he “could sometimes do this when [he] could do nothing else from illness.” Orrego and Quintana further write that Darwin “had no special troubles when writing the first volume of his Natural Selections book on the transmutation of species.” At first when he was doing this work Darwin was in relatively stable health. But as his work progressed, he began feeling “very much below par,” and he went for hydropathy treatment at Moor Park. There, as he continued to work on Natural Selections, he had a return of his “old vomiting,” which caused him to describe himself as a “wretched contemptible invalid.” He was at Moor Park, under the care of Dr. Lane, when he changed from writing Natural Selections to writing On the Origin of Species. This change greatly exacerbated his illness.6 Orrego and Quintana write that during Darwin’s life “the most accurate diagnosis” of his illness was made by Dr. Lane, who said he suffered from “dyspepsia of an aggravated character.” They then comment that at the time this diagnosis “was the closest...