On 20 May 1865, Emma Darwin recorded in her diary that John Chapman, a prominent London publisher who had studied medicine in London and Paris in the early 1840s, visited Down to consult with Darwin about his ill health. In 1863 Chapman started to treat epilepsy with ice and developed a theory of ‘neuro-dynamic medicine’ according to which many diseases were treatable through applications of heat or cold to the spine over long periods.
Chapman wasn’t the first medical practitioner Darwin contacted around this time. In 1863, Darwin experienced a period of severe illness, which improved by March 1864 under the care of the physician William Jenner. In November and December of 1864, however, his health grew worse. In his ‘Journal’, Darwin wrote that he fell ill again on 22 April 1865 and was unable to ‘do anything.’ Emma Darwin’s diary records that he experienced almost daily attacks of vomiting from 21 to 30 April. On 16 May having suffered more attacks of vomiting and seeking another opinion, Darwin wrote to Chapman. On the day that Chapman visited, Darwin wrote an account of the various symptoms of the illness that had extended over most of his adult life.
The note below was found together with letters from Darwin to Chapman, and was evidently written for Chapman’s use in consultation. 
Note on Darwin’s Health
Age 56-57. – For 25 years extreme spasmodic daily & nightly flatulence: occasional vomiting; on two occasions prolonged during months.  Extreme secretion of saliva with flatulence Vomiting preceded by shivering, hysterical crying dying sensations or half-faint. & copious very palid urine. Now vomiting & every paroxys[m] of flatulence preceded by singing of ears, rocking, treading on air & vision. focus & black dots  All fatigues, specially reading, brings on these Head symptoms ?? nervousness when E. leaves me. 
(What I vomit intensely acid, slimy (sometimes bitter) corrodes teeth.) 
Doctors puzzled, say suppresssed gout  Family gouty.  No organic mischief, Jenner & Brinton. 
Tongue crimson in morning ulcerated– stomach constricted dragging. Feet coldish.–Pulse 58 to 62–or slower & like thread. Appetite good–not thin. Evacuation regular & good. Urine scanty (because do not drink) often much pinkish sediment when cold– seldom headach or nausea.–
Cannot walk above ½ mile– always tired– conversation or excitement tires me most. 
Heavy sleep– bad day.
Eczema– (now constant) lumbago– fundament–rash. 
Always been temperate– now wine comforts me much– could not take any formerly.  Physic no good  Chalk & Magnesia.  Water-cure & Douche– Last time at Malvern could not stand it 
I fancy that when much sickness my stomach is cold–at least water is very little warmed.
I feel nearly sure that the air is generated somewhere lower down than the stomach & as soon as it regurgitates into the stomach the discomfort comes on–
Does not throw up the food. 
Instruction– How soon any effect? long long continue treatment? 
 A previous transcription of the note, published in Colp 1977, pp. 83-4, contains a number of errors. Colp’s transcription has also appeared in whole or in part in Bowlby 1990, pp. 6-7, A. Desmond and Moore 1991, p. 531, and R. Porter and Rousseau 1998, p. 163. A wide range of modern medical explanations have been given for CD’s symptoms; for references to the extensive literature on CD’s health, see Colp 1977 and 1998, and Bowlby 1990.
 On CD’s early stomach troubles, see Correspondence vol. 2, letter to Caroline Wedgwood, [May 1838], and letter to Robert FitzRoy, [20 February 1840]. CD’s health diary (Down House MS), which he kept between 1 July 1849 and 16 January 1855, describes almost daily occurrences of flatulence (see Colp 1977, pp. 46-7). CD first mentioned attacks of ‘periodical vomiting’ in a letter to W. D. Fox, [7 June 1840] (Correspondence vol. 2). He suffered from persistent sickness in 1849, describing ‘incessant vomiting’ in his letter to Richard Owen, [24 February 1849], and ‘vomiting every week’ in his letter to J. D. Hooker, 28 March 1849 (Correspondence vol. 4). Throughout the winter of 1863 and spring of 1864, he was sick almost daily (see Correspondence vol. 12, letter from Emma Darwin to W. D. Fox, [6 May 1864]). According to Emma Darwin’s diary (DAR 242), such regular attacks had occurred again in the last week of April 1865, and the third week of May, just before CD’s decision to consult John Chapman.
 Shivering or trembling, faintness, and black spots had been noted in journal entries and correspondence during periods of sickness in 1848, 1852, and 1859 (see Colp 1977, pp. 38, 47, 64). Fainting and ‘rocking’ had been recorded in Emma Darwin’s diary (DAR 242) on several occasions in 1864 and 1865. ‘Bad hysteria & sickness’ were recorded in Emma Darwin’s diary for 18 October 1864. No other record of ‘hysterical crying’ or ‘dying sensations’ has been found.
 On CD’s reliance on Emma Darwin’s companionship and care see, for example, Correspondence vol. 4, letter to Emma Darwin, [27-8 May 1848]. See also Browne 1995, pp. 428-9. On his difficulties reading, see letters to J. D. Hooker, 1 June  and 27 [or 28 September 1865]. Emma or another member of the household regularly read to CD at intervals during the day and in the evening (see LL 1: 113, 118-19, 121-5, and A. Desmond and Moore 1991, pp. 359, 529).
 In his letter to Chapman of 16 May , CD stated that his sickness was ‘always caused by acid & morbid secretions’. CD had sometimes noted the acidity of his vomit in his health diary (Down House MS; see Colp 1977, p. 47).
 CD’s condition had been diagnosed as ‘suppressed gout’ by Henry Holland in 1849 (Correspondence vol. 4, letter to W. D. Fox, 6 February ; see also Correspondence vol. 7, letter to Adam Sedgwick, 24 August ). According to some medical literature of the period, stomach disorders such as dyspepsia and flatulence could be caused by the same accumulation of toxic substances that, in outward attacks of gout, caused pain and inflammation of the joints (see, for example, Holland 1855, p. 233, and Garrod 1863, pp. 263-4). The diagnosis of suppressed gout may also have been made more recently by William Brinton, William Jenner, and George Busk (see letter to J. D. Hooker, [7 January 1865], and letter from George Busk, 28 April 1865). For a discussion of the diagnosis, see Colp 1977, pp. 109-11, and R. Porter and Rousseau 1998, pp. 155-6, 162-4, 170-1.
 CD believed that his father had suffered from gout (see Correspondence vol. 1, letter to W. D. Fox, [25-9 January 1829], and Correspondence vol. 2, letter to Sarah Elizabeth Wedgwood, [28 August 1837]). His grandfather, Erasmus Darwin, had described his own attacks of gout in his Commonplace book, p. 89 (Darwin Library-Down; see King-Hele 1999, pp. 161-2). Erasmus also wrote a letter to CD’s father, in which he claimed that CD’s great-grandfather, Charles Howard, had died of gout (see Autobiography, p. 224). CD discussed gout as an inherited disease in Variation 2: 7, 77-8. On Victorian views of hereditary illness, see Olby 1993.
 In November and December 1863, CD had consulted the stomach specialist, Brinton, who had prescribed mild acid solutions to aid digestion (Correspondence vol. 11, Emma Darwin to W. D. Fox, 8 December ). In his letter to J. D. Hooker, 10 [November 1863] (Correspondence vol. 11), CD wrote that Brinton did not believe his brain or heart to be ‘primarily affected’. In March 1864, CD began to consult Jenner, who prescribed alkali and purgative substances in conjunction with dietary restrictions (see Correspondence vol. 12, letter to J. D. Hooker, 13 April , letter from William Jenner to [William Walmisley Baxter?], [after 7 May 1864?], and letter from William Jenner, 14 August 1864). In his letter to J. D. Hooker, 26[-7] March  (Correspondence vol. 12), CD remarked that Jenner had found ‘no organic mischief’.
 CD often remarked that excitement, conversation with visitors, or any departure from his normal routines made him exhausted or sick, and he frequently excused himself from social occasions on these grounds (see, for example, Correspondence vol. 2, letter to J. S. Henslow, 14 October , Correspondence vol. 7, letter to Robert Monsey Rolfe, 10 November , and Correspondence vol. 12, letter to F. T. Buckland, 15 December ).
 CD’s various skin conditions are discussed in Colp 1977, pp. 31-2, 47, 98. In his letter to J. D. Hooker, 5 March  (Correspondence vol. 11), CD remarked: ‘A good severe fit of Eczema would do me good & I have a touch this morning & consequently feel a little alive’. See also Correspondence vol. 12, letter from Emma Darwin to J. D. Hooker, 17 March .
 On CD’s consumption of alcohol, see LL 1: 118, and Colp 1977, p. 103.
 CD tried a variety of medications over the course of his illness, including calomel (mercurous chloride), logwood, cinnamon, potassium bicarbonate, croton, aloe, bitters, bismuth nitrate, mineral acids and alkalies (see Colp 1977, pp. 12, 22, 37, 45-6, 65, 76, 78-80). Most recently, he had taken phosphate of iron as a tonic, and purgatives derived from Colchicum autumnale and Podophyllum peltatum (May apple) (see Correspondence vol. 12). A book of prescriptions used by the Darwin family, some of which are in CD’s hand, is in Down House (‘Receipts and memoranda book’), and has been transcribed in Colp 1977, pp. 147-67.
 CD began taking small, frequent doses of chalk, magnesia, and other antacids in March 1864 (see Emma Darwin’s diary, DAR 242, and n. 8, above). He reported that the treatment, prescribed by Jenner, had checked his chronic vomiting (Correspondence vol. 12, letter to J. D. Hooker, 13 April ).
 CD had undergone hydropathic treatment on occasions for many years and had at first been enthusiastic about the treatment initially (see, for example, Correspondence vol. 4, letter to W. D. Fox, 24 [March 1849], and Correspondence vol. 7, letter to W. D. Fox, 13 November ). He first visited the establishment of James Manby Gully at Great Malvern, Worcestershire, where he and his family spent three months in March 1849 (see Correspondence vol. 4). He also took regular treatments in a specially built bath at Down for several years (see Correspondence vol. 4, letter to J. D. Hooker, 12 October 1849, and Colp 1977, pp. 43-6). He underwent hydropathic treatments at Moor Park, under Edward Wickstead Lane, between 1857 and 1859, and at Ilkley, under Edmund Smith, in 1859 (see Correspondence vols. 6 and 7). He also stayed at Lane’s new establishment in Sudbrook Park, Surrey, at the end of June 1860 (Correspondence vol. 8). CD’s last hydropathic treatment was taken at Malvern Wells, under James Smith Ayerst, in September and October 1863 (see Correspondence vol. 11, letter from Emma Darwin to W. D. Fox, 8 December , and Appendix II). On CD’s use of hydrotherapy, see Browne 1990.
 The section, ‘I feel nearly … food’, is in Emma Darwin’s hand. In a letter to J. D. Hooker, [20-] 22 February  (Correspondence vol. 12), CD remarked that his vomiting usually occurred two to three hours after eating, and that he seldom threw up food.
 According to Emma Darwin’s diary (DAR 242), CD began the ice treatment on 20 May 1865. In his letter to Chapman of 7 June 1865, he reported that the ice had failed to stop either flatulence or sickness. By the second week of July, he had evidently given up the treatment (see letter from Charles and Emma Darwin to J. D. Hooker, [10 July 1865]).
Provenance: University of Virginia Library, Albert and Shirley Small Special Collections Library, Darwin Evolution Collection (3314)