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April 23, 1997

The Dueling Diagnoses of Darwin-Reply

Author Affiliations

The University of Iowa College of Medicine Iowa City

JAMA. 1997;277(16):1276-1277. doi:10.1001/jama.1997.03540400026016

In Reply.  —The letters discussing our article show continued interest in a subject that has caused much debate over the years. A central issue in that debate has been whether Darwin's illness was physical or psychological. His physicians were baffled, and subsequent investigators, faced with myriad somatic and psychological symptoms, offered a variety of explanations. Dr Adler1 originally proposed the influential hypothesis that Darwin's illness represented Chagas disease. However, Darwin's symptoms began prior to any contact with the parasite T cruzi, and, as Woodruff2 noted, he was unlikely to have had the extensive exposure required to develop the disease. Medawar3 actually proposed both: Chagas disease and a neurosis in reaction to it. Such a phobic response to physical illness is relatively common and might be considered in Darwin's case. Persons exposed to overwhelming, illness-related events may become fearful and avoid circumstances or activities they regard as dangerous.While acknowledging