|Fig. 1 Diagram of a douche, from John Smedley, Practical Hydropathy.|
Charles Darwin (1809-1882) suffered from a relapsing, incapacitating illness for most of his adult life with a bewildering array of symptoms.1 The first symptoms appeared when he was a medical student in Edinburgh (1825-1827), where he was unable to witness surgical procedures and was noted to have a “weak stomach.”2 Later, when studying at Cambridge (1827-1831), he had two episodes of intense fatigue, most “terribly knocked up.”3 His persistent, abnormal seasickness on board HMS Beagle (1831-1836) was part of this illness.
After the voyage Darwin’s symptoms increased to the extent that he could be incapacitated for weeks or months at a time.1 He found that any form of stress, even contemplation, would bring on his illness. In a letter to his friend Hooker (Sir Joseph Dalton Hooker, 1817-1911) he wrote: “I fear that my head will stand no thought, but I would sooner be the wretched contemptible invalid, which I am, than live the life of an idle squire.”4
Darwin consulted many doctors and tried different treatments. Most of the therapy was ineffectual if not harmful, and treatments were usually abandoned within a week or two. He tried a form of galvanism with vinegar-moistened brass and zinc wires draped over his body, and he endured ice bags placed along his spine for hours. His medications included purgatives, mercury, hydrocyanic acid, and arsenic. The only treatment that seemed beneficial was “hydropathy” or the “Water-Cure.”
More than forty different diagnoses have been proposed for Darwin’s illness, dating back to his own lifetime. The late Jared Goldstein summed up these succinctly: “Take your pick, there’s something for everybody: hypochondriasis, refractive error, depression, arsenic poisoning, Oedipal complex, pigeon allergy, familial psychosis, chronic brucellosis, chronic anxiety, Chagas’ disease, and more.”5 Darwin had many of the symptoms endured by patients diagnosed today as having cyclic vomiting syndrome,6 including susceptibility to motion sickness, attacks brought on by stress, including pleasurable events (“positive stress”), and obtaining relief from water exposure.7 Darwin also had symptoms of irritable bowel syndrome.8 His condition may have originated from a maternally inherited pathological mitochondrial DNA (mtDNA) mutation.9-12
After a particularly bad period of illness, and urged on by his friends, Darwin undertook a period of treatment with hydropathy, initially at Dr. Gully’s (James Manby Gully, 1808-1883) establishment in Malvern, England.13 Writing to his mentor Henslow (Rev. John Stevens Henslow, 1796-1861) he said: “All last autumn and winter my health grew worse and worse; incessant sickness, tremulous hands and swimming head; I thought I was going the way of all flesh. Having heard of much success in some cases from the Cold Water Cure, I determined to give up all attempts to do anything and come here and put myself under Dr. Gully.”14
Hydropathy had several unpleasant treatment modalities but perhaps the worst was the water douche, where the sufferer was subjected to a cascade of cold water (Figure 1). Being suddenly deluged with as much as two hundred gallons (900 litres) of cold water would dampen even the most hardy. However it seems to have had beneficial effect in Darwin’s case, and with many other notables of his time.
|Fig. 2 Engraving of Sudbrook Park as it would have|
been in Darwin’s time. (Print in possession of author.)
Darwin noticed improvement within days, writing in a letter: “I am already a little stronger & now have had no vomiting for 10 days.”15 And to his cousin William Fox (Rev. William Darwin Fox, 1805-1880) Darwin recorded: “The Water Cure is assuredly a grand discovery & how sorry I am I did not hear of it, or rather that I was not somehow compelled to try it some five or six years ago.”16
Darwin and his family stayed at Malvern for sixteen weeks rather than the intended six (March-June 1849). He then had a douche constructed on the grounds of Down House, where the treatment could be continued by the family butler, Joseph Parslow (1812-1898).17 Darwin’s son, George, recounted how his father continued the water cure at home: “He erected a douche which was shaped something like a very diminutive church & stood close to the well. About noon every day he used to take a douche even in the coldest weather. I remember well one bitter cold day with the snow covering everything waiting about outside until he had finished & that he came out almost blue with cold…”18
Later, in response to a taunt from Fox, Darwin responded: “Your aphorism that ‘any remedy will cure any malady’ contains, I do believe, profound truth, — whether applicable or not to the wondrous Water Cure I am not very sure. — The Water-Cure, however, keeps in high favour, & I go regularly on with douching…”19 As well as initially returning to Malvern, Darwin continued the treatment at several other establishments – with Dr. Edward Lane (Edward Wickstead Lane, 1823-1889) at Moor Park, later at Sudbrook Park in Surrey (Figure 2), as well as with Dr. Edmund Smith (1804-1864) at Wells House, Ilkley, in Yorkshire (Figure 3).
|Wells House, Ilkley, as it stands today (Photo by author).|
There may be two, quite distinct reasons why Darwin improved with this treatment. The first was psychological. Life in the institutions, Gully’s in particular, was monotonous; Darwin was denied his usual mental stimulations. Later in his letter to Henslow he said: “One most singular effect of the treatment is, that it induces in most people, and eminently in my case, the most complete stagnation of mind: I have ceased to think even of Barnacles!”14 (This was during the seven years (1846-1854) Darwin spent working on the classification of the Cirrepedia). He also wrote to his sister Caroline: “I find the noddle & the stomach are antagonist powers, and that it is a great deal more easy to think too much in a day, than to think too little — What thought has to do with digesting roast beef, — I cannot say, but they are brother faculties.”
The second reason is quite different and relates to the treatment itself – activation by water of the mammalian dive response, a complex physiological reflex occurring in all mammals that produces apnea, bradycardia, and peripheral and enteric vascular constriction.21 Blood flow to the brain and heart is maintained at the expense of tissues more tolerant of anoxia. The overall effect is to reduce aerobic (mitochondrial) metabolism while maintaining the function of two essential body components. In humans the reflex is activated by submerging or simply splashing the face. There would be ample opportunity for such a response to be activated with hydropathy therapy. It is of interest that patients diagnosed today as having cyclic vomiting, including cyclic vomiting induced by marijuana abuse, benefit from water exposure.22 One patient wrote: “I don’t know about anyone else, but for me the water provides relief. Hot or cold water may help, bath, shower or waterfall!” and another: “Hot or cold showers, sometime flicking back and forth between hot and cold can help with the nausea.”23
Darwin wrote to his friend Hooker: “I feel certain that the Water Cure is no quackery.”15 He may have been correct in that the benefit from hydropathy may not have been entirely psychological. The usual psychological pressures were present when Darwin returned to Down House and continued treatment there for a further twelve months. However his symptoms must have returned and were only relieved later when he resumed institutional treatment. Clearly psychological factors were dominant but his initial response to the “wondrous water cure” also supports a metabolic component to his symptomatic relief.
- Colp R, Jr. Darwin’s Illness. Gainesville: University Press of Florida; 2008.
- Darwin EA. Letter 13 — Darwin, E. A. to Darwin, C. R. Darwin Correspondence Project Database http://wwwdarwinprojectacuk/entry-13 (letter no 13; accessed 14 February 2011) [Internet]. 1825.
- Darwin CR. Letter 73 — Darwin, C. R. to Fox, W. D. Darwin Correspondence Project Database http://wwwdarwinprojectacuk/entry-73/ (letter no 73; accessed 29 September 2010) [Internet]. 1829.
- Darwin CR. Letter 2099 — Darwin, C. R. to Hooker, J. D. Darwin Correspondence Project Database http://wwwdarwinprojectacuk/entry-2099 (letter no 2099; accessed 28 March 2011) [Internet]. 1857.
- Goldstein JH. Darwin, Chagas’, mind, and body. Perspectives in biology and medicine. 1989;32(4):586-601.
- Hayman JA. Darwin’s illness revisited. BMJ. 2009;339:b4968.
- Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005;3:20.
- Shanahan F. Darwinian dyspepsia: an extraordinary scientist, an ordinary illness, great dignity. Am J Gastroenterol. 2012;107(2):161-4.
- Hayman J. Charles Darwin’s mitochondria. Genetics. 2013;194(1):21-5.
- Wallace DC. Mitochondrial diseases in man and mouse. Science. 1999;283(5407):1482-8.
- Finsterer J, Hayman J. Mitochondrial disorder caused Charles Darwin’s cyclic vomiting syndrome. Int J Gen Med. 2014;7:59-70.
- Finsterer J, Frank M. Gastrointestinal manifestations of mitochondrial disorders: a systematic review. Therap Adv Gastroenterol. 2017;10(1):142-54.
- Browne J. Spas and sensibilities: Darwin at Malvern. Med Hist Suppl. 1990(10):102-13.
- Darwin CR. Letter 1241 — Darwin, C. R. to Henslow, J. S. Darwin Correspondence Project Database http://wwwdarwinprojectacuk/entry-1241/ (letter no 1241; accessed 9 December 2010) [Internet]. 1849.
- Darwin CR. Letter 1236 — Darwin, C. R. to Hooker, J. D. Darwin Correspondence Project Database http://wwwdarwinprojectacuk/entry-1236 (letter no 1236; accessed 16 February 2011) [Internet]. 1849.
- Darwin CR. Letter 1249 — Darwin, C. R. to Fox, W. D. Darwin Correspondence Project Database http://wwwdarwinprojectacuk/entry-1249/ (letter no 1249; accessed 8 December 2010) [Internet]. 1849.
- Browne J. Charles Darwin Voyaging. Princeton: Princeton University Press; 1995.
- Darwin G. Recollections of Charles Darwin. Wyhe, John van ed, 2002- The Complete Work of Charles Darwin Online (http://darwin-onlineorguk/) (accessed 16 February 2011) [Internet]. 1882.
- Darwin CR. Letter 1352— Darwin, C. R. to Fox, W. D. Darwin Correspondence Project, “Letter no 1352,” accessed on 29 June 2019, http://wwwdarwinprojectacuk/DCP-LETT-1352 [Internet]. 1850.
- Darwin CR. Letter 411 — Darwin, C. R. to Wedgwood, C. S. Darwin Correspondence Project Database http://wwwdarwinprojectacuk/entry-411 (letter no 411; accessed 15 February 2011) [Internet]. 1838.
- Panneton WM. The mammalian diving response: an enigmatic reflex to preserve life? Physiology (Bethesda). 2013;28(5):284-97.
- Fleisher DR, Matar M. The cyclic vomiting syndrome: a report of 71 cases and literature review. J Pediatr Gastroenterol Nutr. 1993;17(4):361-9.
- Cyclic Vomiting Association. Forums. http://cvsawebsitetoolboxcom/ [Internet]. 2010.
JOHN HAYMAN, MD, PhD, FRCPA, is an elderly pathologist still teaching part-time at the University of Melbourne. He obtained his PhD on the topic of Charles Darwin’s illness, contending that this illness was due to a maternally inherited pathological mtDNA (MELAS type) mutation. A key publication on this topic is: Hayman J. Charles Darwin’s Mitochondria. Genetics 2013; 194: 21-25 (open access).