More on Darwin's illness: comment on the final diagnosis of Charles Darwin.

Without the possibility of confirmatory exhumation, diagnostic inferences about Darwin's illness must remain speculative. A diagnosis of Darwin's aggregate symptoms must account for not only gastrointestinal distress but also his predominant and excessive retching and the conglomerate of other heterogeneous symptoms. We opine that Crohn's disease, posited as the 'final diagnosis', is not sufficient for subsuming his pleiomorphic symptomatology. An additional proposal is outlined that may help to explain his presentation with heterogeneous symptoms. It incorporates constitutional vulnerabilities, psychosomatic influences and Pavlovian conditioning as explanatory variables.