Two hundred years after the birth of Charles Darwin, the father of evolution, doctors are putting modern medicine to the test to unravel the mystery of the painful illness that plagued the scientist for much of his life. Darwin is the subject of this year's annual Historical Clinicopathological Conference (CPC) sponsored by the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System. This conference, held on Friday, May 6 in Davidge Hall, is devoted to the modern medical diagnosis of disorders that affected prominent historical figures.
Darwin was born in England on Feb. 12, 1809. He suffered from chronic vomiting, abdominal pain, and gastrointestinal distress for much of his life, all while maintaining his career as an incredibly influential scientist and fathering 10 children. A naturalist, traveling the world cataloging and observing wildlife and fossils, Darwin became fascinated by the way species seemed to adapt and change. It was in 1859 that he published his seminal work, On the Origin of Species, detailing his theory of evolution and natural selection. He went on to describe the evolution of humans and sexual selection in later books, and he also published on plants and geology. His work changed the way the world regarded science and serves as the foundation for the field of evolution. Darwin died of heart failure in 1882 at the age of 73.
Now, two centuries after his birth, the Historical Clinicopathological Conference examined both the illness that affected him for much of his life and the heart failure that led to his death. The physician taking up Darwin's case was noted gastroenterologist Sidney Cohen, MD, professor of medicine and director of research at the Jefferson Medical College of Thomas Jefferson University in Philadelphia.
Each year at the conference, the medical expert is joined by a historian who summarizes the life and historical impact of the figure in question. Organizers have taken a different avenue to put Darwin's life into perspective: This year's guest speaker is Ruth Padel, PhD, an award-winning poet and writer who also is Darwin's great-great-granddaughter.
Cohen said he has never taken up a case quite like Darwin's. "This case is quite unusual in that there is no physical evidence -- no X-rays, no blood studies. This is purely a symptom-based assessment, an analysis of this journey of invalidism that he suffered throughout his life," said Cohen.
"Darwin's lifelong history does not fit neatly into a single disorder based historically only upon symptom assessment," he added. "I make the argument that Darwin had multiple illnesses in his lifetime."
Careful review of the details of Darwin's life and health helped Cohen reach three conclusions about the scientist's health and ailments. He believes Darwin suffered from cyclic vomiting syndrome, which was the dominant illness early in his life. Cyclic vomiting syndrome is a condition characterized by a collection of symptoms, mainly patterns of chronic vomiting.
Darwin led a relatively healthy young life until his late 20s. He left home at 22 to travel the globe for the next five years, collecting biological specimens in areas such as South America, the Pacific, the Far East and Africa. He remained healthy for more than a year after returning from his trip. It was then that his symptoms began. His disorder included sudden attacks of abdominal pain, nausea, vomiting and retching, described as "gastric flatus." When the symptoms were at their worst, he vomited after nearly every meal. He seldom vomited food, just stomach acid and other secretions, and his weight and nutrition remained normal. The symptoms match up with those of cyclic vomiting syndrome, says Cohen.
The gastroenterologist also believes Darwin suffered from a parasitic illness called Chagas disease, which he most likely contracted during his five years traveling the globe on the HMS Beagle. Chagas symptoms often lay dormant for years, as they seem to have done with Darwin. "Chagas would describe the heart disease, cardiac failure or 'degeneration of the heart' -- the term used in Darwin's time to mean heart disease -- that he suffered from later in life and that eventually caused his death," explained Cohen.
Cohen has an additional explanation for his abdominal pain and gastrointestinal distress. He believes the scientist also suffered from Helicobacter pylori, the bacteria that cause peptic ulcer disease. "H. pylori and Chagas disease can be contracted in the same areas of the world and often occur together," the doctor said.
Physicians of his time diagnosed Darwin with dozens of conditions, including schizophrenia, appendicitis, lead poisoning, and lactose intolerance. He was treated with cures of the day, including arsenic, hydrotherapy, aloes, strychnine, and codeine, which provided at most temporary relief. Unfortunately, doctors practicing in Darwin's lifetime would not have known about the conditions Cohen has diagnosed, and would not have had access to our modern treatments.
"For the most part, none of these illnesses were described during Darwin's lifetime," said Cohen.
"It is particularly poignant that the scientists and physicians of his time could not provide Darwin, the father of modern life sciences, with relief from the ailments that affected so much of his life," said Philip A. Mackowiak, MD, MBA, professor and vice chair of the Department of Medicine at the University of Maryland School of Medicine and chief of the VA Maryland Health Care System's Medical Care Clinical Center.
Mackowiak founded the annual CPC in 1995, and the program has since examined the lives and deaths of famous figures such as Edgar Allan Poe and Abraham Lincoln. "This is precisely the type of historically significant mystery the CPC seeks to unravel. We hope examination of this case adds to the understanding and appreciation of this great man, who was able to accomplish so much despite his medical condition."
E. Albert Reece, MD, PhD, MBA, vice president for medical affairs of the University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor and dean, School of Medicine, says the conference captures the very essence of medicine. "As doctors and scientists, we are medical detectives seeking to unlock the secrets of human health," said Reece. "The CPC applies those skills to obtaining a better understanding of figures in history who have made a significant impact on humankind."
Cohen said his respect for Darwin grew the more he learned about the man. "Darwin was born on the same day as Abraham Lincoln in 1809," he explained. Lincoln was the subject of a previous CPC that examined whether the University of Maryland Shock Trauma Center could have saved the president from the gunshot wound that killed him. "That these two men born on that same day have such a lasting impact on our world 200 years later is extraordinary. I have tremendous admiration for Darwin."