FEATURE

“Steel True, Blade Straight”*: , Joseph Bell and ophthalmology

BY STEVEN KERR

Steven Kerr of the Royal College of Surgeons of explores the medical career of Arthur Conan Doyle, his relationship with his mentor Joseph Bell and his fascination with ophthalmology.

rthur Ignatius Conan Doyle was born modestly claimed to be little more than in Edinburgh on the 22 May 1859. By average academically, describing himself as the time of his death 71 years later “always one of the ruck, neither lingering nor Ahis name (minus the Ignatius) was gaining.” Nonetheless, he graduated MB and to become associated with some of the most CM August 1881 [2] and four years later added significant crime and adventure fiction the the advanced Doctor of Medicine degree world had ever seen. Today, almost 90 years [3]. More significantly though, it was during after his passing, Doyle remains among the his university years that the student doctor most admired novelists, and is celebrated took his first serious steps into the writing of around the globe as the creator of arguably fiction. In October 1879 he earned £3 from the the most famous fictional sleuth of all time, weekly Edinburgh magazine Chambers’ Journal . for his short adventure story The Mystery of It is of course well-known that Doyle Sasassa Valley. This was followed that same trained and worked in medicine before turning year by The American’s Tale, Doyle’s first to his hand to writing professionally, although be published in the monthly London Society whether as a child Doyle himself had intended journal. to take either career path is debatable. Indeed, There is something pleasingly analogous in his 1924 autobiography Memories and about Doyle’s handwritten draft of The Adventures he recalls telling a schoolmaster of American’s Story (as Doyle’s initial title had his ambition to become a civil engineer, only it) and his gradual conversion from man of to receive the reply, “Well Doyle, you may be medicine to man of words, in that the story is Figure 1: Page 1 of handwritten draft The American’s Story. From the collections of The Royal College of Surgeons of an engineer, but I don’t think you will ever be written in a medical notebook. Entitled ‘Notes Edinburgh. a civil one.[1]” Later in the same book, Doyle on Medicine Session 1879-80. Compiled writes that (having returned to Scotland from from the Clinical Class from the infirmary schooling in Stoneyhurst, Lancashire) “It had wards, and from epitomes of the Systematic been determined that I should be a doctor class’, the notebook – acquired by the – chiefly, I think, because Edinburgh was so Library of The Royal College of Surgeons of famous a centre for medical learning [1].” Edinburgh in 2004 – includes revision notes While the description of Scotland’s capital is on the constitutional complications of gout, undoubtedly accurate, Doyle’s phrasing hardly treatments of rheumatism, and clinical details suggests a person in sole control of his destiny of named patients and their symptoms. at the time, although he would be acutely But it also has 30 pages dedicated to the aware of the sacrifices made by his mother, aforementioned short story (about the death Mary, to provide for her family despite the of Joe Hawkins in Montana (“Alabama Joe as alcoholism and increasing mental illness of he was called thereabouts. A regular out and her husband, Charles Altamont Doyle. outer he was, ‘bout the darndest skunk as ever Arthur commenced studies at the man clapt eyes on”) and a humorous poem University Medical School in 1876. He celebrating the Royal College of Surgeons of

“It could be argued that almost as valuable to the degrees Doyle earned was his meeting certain lecturers, whose Figure 2: ‘The Royal College of Surgeons of Edinburgh’ – handwritten poem by Arthur Conan Doyle. characters he found lent themselves very well to his literary From the collections of The Royal College of Surgeons of Edinburgh. creations”

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Figure 3: Arthur Conan Doyle. Photographed by Herbert Rose Barraud, 1893. Figure 4: Joseph Bell in deerstalker. From the collections of The Royal College of Surgeons of Edinburgh.

Edinburgh itself, the second verse of which Edinburgh surgical family dynasty spanning to the new Department of Surgery in the reads: over a century-and-a-half [4]. Born in Royal Hospital for Sick Children in 1887. His ‘For there’s many a pickle in jar and in Edinburgh in 1837, he was schooled at the care of young patients was renowned, and pot; Edinburgh Academy and qualified MD from often to the disregard of his own well-being, The Examining fogies there have got; the University in 1859. Probably destined to illustrated by the time when – as a young And they want you to know the devil be a surgeon given his family history, Joseph practitioner – he contracted diphtheria from knows what; immersed himself in a life of medicine, a child patient [6]. In a diary entry from June At the Royal College of Surgeons.’ starting during his academic years when he 1864 Bell wrote: “Since Monday I have been served as President of The Royal Medical confined to bed with pretty bad diptheric A third short story, The Gully of Bluemansdyke Society of Edinburgh, one of the oldest sore throat...which I probably acquired by was published by London Society in 1881, the students’ societies in the world [5]. Like his direct contact from sucking child Brittain’s year of Doyle’s graduation. great-grandfather, grandfather and father throat.” before him, he was to become a Fellow of He had inserted a pipette into the child’s Joseph Bell The Royal College of Surgeons of Edinburgh, windpipe and sucked out harmful mucus Of his academic years, Doyle was to admitted in February 1863. He also served from the child’s throat, but in the process write in his autobiography that “There separate terms as Secretary and Treasurer of (and perhaps unsurprisingly) caught was no attempt at friendship, or even the same institution, eventually becoming diphtheria himself. The illness was to leave acquaintance, between professors and RCSEd President in 1887. In addition he Bell with a slight limp, noted by Doyle students at Edinburgh. It was a strictly edited the Edinburgh Medical Journal for over who was to describe his teacher as having business arrangement [1].” However, it 20 years. “a jerky way of walking.” That said, in the could be argued that almost as valuable In the operating theatre, Bell was an same description of Bell there is also the to the degrees he earned was his meeting outstanding paediatric surgeon, and was an suggestion of the classic image of Sherlock certain lecturers, whose characters he obvious choice to become the first surgeon Holmes, perhaps reminiscent of the screen found lent themselves very well to his literary creations. For example, there was William Rutherford, Professor of Physiology “Specific diagnoses based on deduction also came readily & Anatomy, and who partly inspired (both in physique and personality) the to Bell, who regularly used real patients with which to bearded, domineering zoologist in The Lost World. But even more test his students, challenging them to identify ailments significantly, there was Joseph Bell. through simple observation and logic” Joseph Bell was the last of a great

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Figure 5: Joseph Figure 6: Letter from Arthur Bell in FRCSEd Conan Doyle to Joseph gown. From the Bell, 4 May 1892. From the collections of The collections of The Royal Royal College College of Surgeons of of Surgeons of Edinburgh. Edinburgh.

depictions by Basil Rathbone or Peter real patients with which to test his students, his specialty, Eugene claimed to have found Cushing. “He was thin, wiry…with a high- challenging them to identify ailments his wife in bed overcome by a gas leak. nosed acute face, penetrating grey eyes and through simple observation and logic. On However, Littlejohn and Bell discovered that angular shoulders [1].” one occasion he demanded a diagnosis of a in the preceding months Chantrelle had Joseph Bell’s early surgical career man with a peculiar limp, to which a nervous purchased large quantities of opium from had involved working as assistant to the student suggested hip-joint disease. Bell’s city pharmacists. They also traced a gasfitter legendary James Syme, and he also served response is truly Sherlockian. who had worked on the Chantrelle home two years as demonstrator in anatomy to “Hip-nothing! The man’s limp is not from his and who noted that the linguistics teacher John Goodsir, the distinguished anatomist hip, but from his feet. Were you to observe had expressed a curious interest in the credited as the first to introduce the closely, you would see that there are slits, workings of the house’s gas supply. Nor did compound microscope to Edinburgh. Both cut by a knife, in those parts of the shoes it go unnoticed that a large insurance policy Syme and Goodsir helped instil in Bell the where the pressure of the shoe is greatest was in place against Mrs Chantrelle’s life. importance of observation and attention against the foot. The man is a sufferer from Duly found guilty and sentenced to hang, to detail, and by the time he was appointed corns, gentlemen. But he has not come Chantrelle is said to have turned to the lecturer in surgery at the Extra Mural School here to be treated for corns. We are not attending Littlejohn and muttered, “Give of Medicine (run, not by the University, but chiropodists, gentlemen. His trouble is of my compliments to Joe Bell. He did a good conjointly by the surgeons and physicians a much more serious nature. His is a case job in bringing me to the scaffold.” Ironically, of the two Edinburgh Royal Colleges), Bell of chronic alcoholism. The rubicund nose, through his crime Chantrelle himself was to was recognised among the capital’s medical the puffed, bloated face, the blood-shot inspire a legendary literary figure – Robert students as not only a fine surgeon, but also eyes, the tremulous hands and twitching Louis Stevenson’s Dr Jekyll. something of a genius in diagnostic acumen. face muscles, the quick, pulsating temporal Although Doyle was to acknowledge One such student was Arthur Conan arteries. These deductions, gentlemen, in his autobiography that he thought of Doyle, who enrolled in Bell’s clinical surgery must, however, be confirmed by absolute Bell’s “eagle face, of his curious ways, of his class in 1878 and quickly became enamoured and concrete evidence. In this instance eerie trick of spotting details” [1] in 1887 with Bell’s often entertaining – almost my diagnosis is confirmed by the fact of when writing the first Sherlock Holmes playful – manner of demonstrating the value my seeing the neck of a whisky-bottle story, , it would be wrong of observation. This was well illustrated by protruding from the patient’s right-hand to suggest Bell was the sole inspiration for his legendary routine in which – extolling the coat pocket [5].” Sherlock Holmes. The author recognised benefits of using all five senses to observe It is also worth noting that Bell was the influence that Edgar Allen Poe’s fictional – he would dip a finger into a bitter solution no stranger to criminal investigative French detective C. Auguste Dupin had on and taste the foul concoction. Wincing with procedures. On several occasions his work; the aforementioned Littlejohn revulsion, he would invite his students to do throughout the 1870s he assisted Dr Henry (who lectured Doyle in ) the same which, of course, they all did. He Littlejohn, Edinburgh’s first Medical almost certainly played a part in the would then point out that each had failed Officer of Health, Professor of Medical character’s development; and of course this particular test of observation by not Jurisprudence and Chief Surgeon to the City many will argue that the only person who noticing that he had dipped his index finger Police. Perhaps the most famous of these can legitimately claim to be Sherlock into the solution, but his middle finger into cases was the 1878 murder of Elizabeth Holmes is Doyle himself. his mouth. Chantrelle, poisoned by her French husband However, there can be little better Specific diagnoses based on deduction Eugene. In a scenario reminiscent of the primary evidence as to the sleuth’s also came readily to Bell, who regularly used fictional murder plots Doyle was to make inspiration than a letter from Arthur Conan

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Doyle to Joseph Bell, the lecturer who had It was during this time that he developed been used to inflict a small wound on the become his friend, dated 4 May 1892, a year an interest in the treatment of the eye, and leg of the eponymous racehorse. In the after a serialisation of Holmes stories in as well as performing eye tests he regularly story it is described by Holmes as “a very The Strand had gained national recognition. – in Doyle’s own words – “amused himself” delicate blade devised for very delicate The letter, one of a set of seven held by the by correcting refractions and assisting work,” and identified by his medically trained Library of The Royal College of Surgeons noted Ophthalmologist Vernon Ford at the colleague Dr Watson as a cataract knife of Edinburgh states: “It is most certainly to Portsmouth Eye and Ear Infirmary. In 1888, [10]. In addition, Dr James Ripley in the 1894 you that I owe Sherlock Holmes, and though Doyle wrote to his sister, Lottie, indicating work The Doctors of Hoyland is described in the stories I have the advantage of being that he was considering a permanent early in the tale as enjoying spending “half able to place him in all sorts of dramatic switch to ophthalmology, and signalled his the night performing iridectomies and positions I do not think that his analytical intention to study the specialty further in extractions upon the sheep’s eyes sent in work is in the least an exaggeration of some major European cities like Paris and Berlin, by the village butcher, to the horror of his effects which I have seen you produce in the before setting up practice on Harley Street. housekeeper, who had to remove the debris outpatient ward [7].” This best-laid plan did not materialise as next morning.” That same year Doyle was actually to let intended, however, and by 1890 Doyle was Thus, by supplying even the smallest slip to a journalist (Harry How) the level of still in Southsea. However, on an unrelated points of reference to be included in the inspiration Bell had given him for Holmes. trip to Berlin that year he had a chance stories of one of the greatest authors of all How wrote an article in The Strand naming meeting with dermatologist Sir Malcolm time, Doyle’s brief foray into ophthalmology Bell, which led to some consternation for Morris. Morris had achieved Doyle’s aim of can probably be considered a successful one. his former student, as illustrated in another success on Harley Street and warned the letter in which Doyle writes: “I fear that one younger man (now married and with an References effect of your identity being revealed to the infant daughter) that he was wasting his * Inscription on the grave of Sir Arthur Conan Doyle readers of The Strand will be that you have medical career in the provinces. Learning of (1859-1930). ample opportunity for studying lunatic Doyle’s interest in the eye, Morris advised 1. Doyle AC: Memories and adventures. Wordsworth letters, and that part at least of the stream that Doyle abandon practice in England and Editions: London, UK; 2007. 2. Lycett A: Conan Doyle: the man who created Sherlock which pours upon me will be diverted to you study ophthalmology in Vienna. Holmes. Weidenfeld & Nicolson: London, UK; 2007. [8].” Doyle took Morris at his word, and 3. Ravin JG, Migdal C. Sir Arthur Conan Doyle: the enrolled in classes at the city’s general author was an ophthalmologist. Surv Ophthalmol Arthur Conan Doyle and hospital, the Allgemeines Krankenhaus. 1995;40(3):237-44. Alas, the training venture was not a 4. Macintyre I, MacLaren I (eds): Surgeons Lives, Royal ophthalmology College of Surgeons of Edinburgh. An anthology of College Despite Doyle’s modesty about his academic successful one. Doyle quickly found both Fellows over 500 years. The Royal College of Surgeons of skills, the oft-held belief that he was a his practical experience in ophthalmology Edinburgh: Edinburgh, UK; 2005. failed physician who found professional and his knowledge of technical German 5. Liebow EM: Dr. Joe Bell: model for Sherlock Holmes. University of Wisconsin Press: Madison, USA; 1982. redemption in writing is probably unfair. to be lacking. The intended six months 6. Mackaill A, Kemp, D: Conan Doyle & Joseph Bell: the Soon after graduating in 1881, he found stay in Austria’s capital lasted barely a real Sherlock Holmes. The Royal College of Surgeons of employment as ship’s surgeon on the third of that, and the family returned to Edinburgh: Edinburgh, UK; 2007. steamship Mayumba on a voyage to the England in March 1891. Doyle was, however, 7. Letter from Arthur Conan Doyle to Joseph Bell. May 1892. Held by The Royal College of Surgeons of West Indies, caring for the health of some undeterred in his pursuit of specialising Edinburgh. Ref: GD 16/1/2/1/2 in ophthalmology, opening a practice in 30 passengers, until its return in early 8. Letter from Arthur Conan Doyle to Joseph Bell. May 1882 [2]. Doyle then moved to the south of London only the following month and 1892. Held by The Royal College of Surgeons of England to commence private practice as joining the Ophthalmological Society of the Edinburgh. Ref: GD 16/1/2/1/5 a GP, first for a brief spell to Plymouth, and United Kingdom. He recognised that his 9. Snyder C. There’s money in ears, but the eye is a skills would probably not extend to hugely gold mine: Sir Arthur Conan Doyle’s brief career in then to Portsmouth where he was to hold a ophthalmology. Arch Ophthalmol 1971;85(3):359-65. respected – though not especially lucrative complex surgeries of the eye, but he believed 10. Craig PC. Memoirs of Sherlock Holmes through the – practice for almost a decade in the suburb he could make a decent living on the more eyes of an ophthalmologist. Trans Pa Acad Ophthalmol of Southsea, his income supplemented by standard procedures of refractions and Otolaryngol 1972;25(1):42-3. around £10 to £15 a year from his writing [9]. retinoscopy, of which he had experience, and which were often ignored by larger practices. His new building also had the advantage of being large enough to accommodate a writing room. This was perhaps just as well, as patients visiting his surgery were to prove “In 1888, Doyle wrote to scarce in the proceeding weeks, and Doyle’s his sister indicating that diary indicates that he abandoned the practice of ophthalmology less than a month AUTHOR he was considering a after starting. The same year, The Strand permanent switch to magazine was founded and began regularly publishing his Sherlock Holmes stories, and ophthalmology, and the rest, as they say, is history. Like so many episodes of Doyle’s personal Steven Kerr, signalled his intention life though, his brief experience in treatment College Librarian, to study the specialty of the eye provided him with material to The Royal College of use in his writing. For instance, in the 1892 Surgeons of Edinburgh, Edinburgh, UK. further in major Holmes short story The Adventure of Silver Blaze, “an ivory-handled knife with a very European cities” delicate, inflexible blade,” is found to have

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