To the Editor.
—Drs Barloon and Noyes1 excluded Meniere disease in Darwin in the alleged absence of aural fullness, tinnitus, or hearing loss. However, there is overwhelming evidence for subclinical Meniere disease with a very plausible cause: acoustic trauma. Before 1861 Meniere disease was "gastric vertigo" (Charcot2) or "suppressed gout,"3 Darwin's 1848 diagnosis.4Perceived pressure in the head or ear is often ignored by patients and physicians.2,5 For example, Van Gogh2 had "the profound feeling at times that his mind was a turbid pool" and "a feeling of emptiness or fatigue in the head." Hughlings-Jackson3 reported that after firing 2 shots at a bird, a fit young surgeon had chronic Meniere symptoms3 "with a full heavy dull feeling in my head, and it seems to deaden my intellect, and render me powerless for consecutive thought." Darwin4 wrote, "I have now been six days with
Gordon AG. The Dueling Diagnoses of Darwin. JAMA. 1997;277(16):1276. doi:10.1001/jama.1997.03540400026015
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