MEDICAL MATTERS IN THE SHERLOCK HOLMES STORIES FROM, THE RECORDS OF JOHN H. WATSON, M.D.

H. S. CARTER, m.d., d.p.h.

No account of the medical allusions, at the hand of Dr. Watson, in the detective stories of Conan Doyle, can be attempted without reference to Sherlock Holmes. Indeed, to reverse R. A. Knox's somewhat obvious conclusion, studies in Dr. Watson are essentially studies in Sherlock Holmes. The world's most famous fictional detective was in continuous ' practice from about 1873, when he handled the mystery of the Gloria Scott,' until 1903, the year of the curious affair of The Creeping Man. Soon after this case, being then somewhat afflicted by rheumatism, he retired to a cottage on the South Downs where he occupied his leisure in bee-keeping and philosophy. For some years he evidently lost touch with Watson, but still kept an interest in his profession and was occasionally consulted, for he wrote up two cases himself, The Blanched Soldier from his record of 1903 and The Lion's Mane, an unusual problem which came to him after his retirement. Iyater, in 1912, when he must have been about sixty, he undertook for the government of the da}* the uncovering of the German espionage organisation which ended in the discomfiture of von Bork, the master-spy, 011 the eve of the first world war (Iiis Last Bow). Watson, who had again been summoned to help, at any rate, in the later stages of this affair, is the author of almost all the accounts of Holmes' cases that have been given to the world. It is true that commentators doubt the authenticity of some, and even suggest faking or the intervention of alien editorial hands : but it is obvious that Watson's notes form the basis of the whole saga, and that he himself, despite his atrocious memory and occasional infelicity, is the author of the romantic reconstructions. Watson's stvle is unmistakable.

The scene of so many of the triumphs which covered a period from the middle of the late Victorian era through the brilliant Edwardian reign will be familiar to older readers. The cosy, gas-lit, untidy interior of 221b Baker Street, presided over by that greatest and most long- suffering of landladies, Mrs. Hudson, was redolent of the odour of London shag, and was warmed by a cheery fire of sea-coal. That first floor room littered with the impedimenta of the great detective's occupation ; the acid-burnt chemical bench, the violin, the cocaine bottle and syringe, the classified reference books, the pile of daily newspapers?all editions, the gazogene, the tobacco in the toe of a Persian slipper and the cigars in 414 MEDICAL MATTERS?CARTER 415 the coal-scuttle, the patriotic V.R. in bullet-pocks 011 the wall, to say nothing of the pipe-dottles 011 the mantel-piece to which convenient wooden structure his correspondence was transfixed by a knife : this was the colourful centre of operations and a refuge from the frequently atrocious London weather through which Holmes and his faithful Boswell, Dr. Watson, traced the threads of crime in the web of life around them. The weather was indeed helpful very often, not only to the criminal at large, but as a sort of circumambient setting, sombre and dark, stormy or breathless, for the opalesque lighting of the centre of the picture. The ' ' dense, greasy, yellow wreaths of the old London particular whirling down Baker Street, drifting past their windows and obscuring the houses opposite, sinister to a degree ; the howling wind and fierce rain of tem- pestuous nights when solitary hansoms splashed along the road and the lights from the gas-lamps were fitfully reflected from the wet pavement; the August heat when the town was like an oven and even breathing was difficult?all helped in full measure to frame vividly the exploits of the two most familiar figures in modern fiction. Within, Holmes clad in his blue dressing gown?it was later purple and probably became subfusc with age?paces restlessly or sits on one side of the fire indexing his records of crime ; and on the other side, intermittently, sits Dr. Watson, deep in a recent treatise on surgery or pathology?for he read both. If ' we listen as well as look we shall hear wheels : a brougham and a pair of ' beauties. Worth a hundred and fifty guineas apiece (A Scandal in Bohemia), bringing a king to consultation. Or again, we hear the clip- clop of a horse's hooves as Holmes skilfully drives a dog-cart out of London into Kent (The Man with the Twisted Lip). Together, this tall ascetic figure, eagle-beaked, and wearing a deer-stalker cap, accompanied ' by that whetstone for his mind,' Dr. Watson, together they travelled the rambling English road and most of the railways leading out of town : ' and their knowledge of London was like Sam Weller's, extensive and peculiar.' With these preliminary sentimental concessions to Romance we may proceed to the purpose of this paper, which is to examine the medical references in the Sherlock Holmes stories. For the most part this means the medical knowledge exhibited by Dr. John H. Watson, once un- the Twisted accountably referred to by his wife as James (The Man with Lip)? Watson was a Bart's man, and qualified in the middle seventies. He took his M.D. London in 1878, joined the Army, went to India with the Northumberland Fusiliers and was wounded at Maiwand in 1880. the bullet struck his shoulder, just grazing the subclavian artery. He has probably lucky not to develop an aneurism which might have given the surgeons of that time more trouble than it would their successors to-day, with improved technique and the experience of the late wars. After being in hospital at Peshawar he contracted a severe attack of 416 GLASGOW MEDICAL JOURNAL

enteric fever. Nowadays he would have been immunised with T.A.B. and might have escaped. Considering his weakened condition from his wound and the enteric case fatality rate then, he was fortunate to recover. Soon after his return to I,ondon he met Sherlock Holmes and the famous partnership began (A Study in Scarlet). It appears later that he had a jezail bullet also through his leg which damaged his tendo Achillis (The Sign of Four). Watson, although he probably engaged in practice three times during his career, found his real vocation at the end of his first adventure with Sherlock Holmes. He had the facts in his journal and was determined the public should hear of them, although Scotland Yard took the credit at the time. It would have taken credit for most of Holmes' successes had it not been for the faithful Watson, for to ' ' Holmes a case was merely a problem?sometimes a three pipe problem ??and had little interest for him after he had solved it. Any doctor reading Watson's descriptions of Holmes' exploits must be struck by the large number of references to matters of medical and scientific interest. There are well over a hundred, so it is impossible to deal with them all. Watson was not present on all occasions, but he states the facts and we can theorise on facts.

The aneurism of Jefferson Hope (A Study in Scarlet) makes a good starting point. Watson palpated the chest and felt the shuddering chest wall and the throbbing commotion within. He heard the loud murmur as they stood in the quiet room. Although he carried his stethoscope in his hat, it is doubtful if he used it here. There was no need. The physical signs were obvious, and besides, the patient had taken opinion before and confirmed the diagnosis. We may go further and hazard that the aneurism was of the ascending part of the aortic arch?Broadbent's aneurism of physical signs, with a powerfully acting heart causing strong pulsation, rough thrill and loud murmur, and a thudding diastolic shock. Hope was a strong man and had struggled on arrest, but he knew his fate. His aneurism had been getting worse for years and he attributed it to over-exposure and under-feeding during his hard life. No doubt there were changes in the media due to the usual cause. As predicted the aneurism burst before he could be brought to trial. A short, more or less precise description of heart disease is in the account of the death of Capt. Morstan (The Sign of Four). In a fit of anger he clapped his hand to his chest and with cvanosed face fell down. Major Sholto found him dead. John Hunter died similarly. The associa- tion of pain in the chest with a syncopal attack suggests angina pectoris as the probable cause of death. ' Major Sholto himself was a heart case. He was seen propped up in bed and breathing heavily.' Notice the orthopnoea. He made a state- ment with much emotion and in obvious terror, dropped his head and MEDICAL MATTERS?CARTER 417 died suddenly. The Agra treasure was productive of strong emotions. Death might be attributed to arterio-sclerosis, high tension and left ventricular failure. In The Crooked Man Colonel Barclay fell dead suddenly after a quarrel with his wife. He was an old soldier risen from the ranks who had married the prettiest girl in the regiment. At the inquest the verdict was cerebral haemorrhage with head injuries due to his fall. The sudden shock was due to his seeing his old rival whom he believed he had murdered years ago during the Indian Mutiny, and who broke in upon them during the quarrel. The Colonel's sclerosed arteries were not proof against the sudden rise in blood pressure occasioned by his intense emotional dis- turbance. There is another interesting account of death from apoplexy in 7 he ' Gloria Scott,' Holmes' first case in the days before he knew Watson. A mysterious communication about head-keeper Hudson and a hen- pheasant caused James Armitage, otherwise Trevor, to clap his hands to his head and run round in circles. His mouth and eyes were twisted to one side. His son drew him down on a couch realising that he had had a stroke. The paralysis spread and he died next day without regaining consciousness except for a moment. Here surely is a lesion of the posterior inferior cerebellar artery. Commonly it is thrombosis which has a tendency to spread towards the medulla. Intense vertigo comparable to that of Meniere's disease, and sudden falling are usual, together with forced rotatory movements. Watson was not present so that the descrip- tion is incomplete. But it is interesting to note that some time previously Trevor had a syncopal attack activated by Holmes noticing initials tattooed on his arm, detection of which roused powerful emotions. This seizure may have been due to angiospasm and not to an ordinary fainting fit. Trevor probably suffered from hypertension. Rheumatism as a cause of heart disease is mentioned in The Lion's Mane, one of the two stories written by Holmes himself. Again in the had story of Shoscombe Old Place, Lady Falder appears to have dropsy her brother for some years. It got worse and she died, thereby involving in his ingenious concealment of her death. This lady probably suffered from a later stage of rheumatic heart disease. It is quite likely she had a damaged mitral valve and auricular fibrillation. During his career Watson naturally encountered many cases of fainting. It was common in Victorian days and writers made full use of it. Watson fainted himself when Holmes suddenly reappeared some years after his supposed death at the foot of the Reichenbach Falls [The Empty House). The sexes faint impartially in the stories, and indeed there are more instances of men fainting than women. There is a good description of the sensations of fainting due to loss of blood and excite- 418 GLASGOW MEDICAL JOURNAL merit in The Engineer's Thumb ; deadly nausea and dizziness, buzzing in the ears and sudden oblivion. Watson's remedy in these cases was brandy, a supply of which was generally available, but when his fiancee, Miss Morstan, was on two occasions about to faint, she got only water. But then Watson had travelled a good deal; like Ulysses, he had seen ' men and cities, and had an experience of women which extends over ' many nations and three separate continents (The Sign of Four). Sherlock Holmes always left the ladies to Watson, who sentimentally ' ' recorded the dwindling frou-frou of skirts as the loveliest woman in Ivondon left the room (The Second Stain). When Dr. Huxtable fainted 011 their hearth-rug, Watson, brandy in ' hand, and his finger 011 the thready pnlse,' rightly diagnosed absolute exhaustion (The Priory School). Generally the cause was emotion, of which our forebears were more prodigal. There are few references to respiratory diseases by Watson, but as might be expected tuberculosis is not omitted. The Cambridge rugger captain's wife died of virulent consumption despite all Dr. Armstrong's care (The Missing 'Three-Quarter). A faked message about a lad}* with haemoptysis recalled Watson from Holmes' side to the Swiss Hotel when Moriarty wished to separate them (The Final Problem). The description of Athelney Jones in The Sign of Four suggests that he suffered from emphysema and chronic bronchitis, and Holmes quickly noticed that Mr. John Hector McFarlane was asthmatical (The Norwood Builder), though truly the evidence was slight. Holmes himself, in the guise of an old sailor, simulated asthma (The Sign of Four). It can be seen that Dr. Watson was pretty sound 011 the cardio- vascular system and his descriptions run closely with the diagnostic probabilities as a rule. On diseases of the nervous system he is not quite so sound, but he has several interesting observations. There is the case of old Dr. Farquhar of Paddington who sold his practice to Watson for a song because he suffered from a complaint like St. Vitus' dance [The Stockbroker's Clerk), and his connection had fallen away. It is more likely that the old man suffered from Huntingdon's Chorea, Parkinson's Disease or simply senile chorea. Perhaps Watson did not wish to be too technical here, having regard to his public. He can hardly have expected Sydenham's chorea to be understood. Watson was not always very observant, for when Holmes, with rolling eyes and convulsed features simulated something like an epileptic fit, he was deceived (The Reigate Squires) ; but Holmes did it very well, excluding the bitten tongue and the frothing lips, and the ruse was successful. Had there been soap, there might have been froth. ' That ancient syndrome brain-fever' crops up now and again. ' ' Tadpole Phelps had a fit at the station when he imagined his career MEDICAL MA TTERS?CARTER 41U to be hopelessly ruined by the loss of an important official document {The Naval Treaty) and thereafter was ill nine weeks with brain fever. The Welsh maid in The Musgrave Ritual became acutely ill with delirium and hysterical symptoms for two days after her startling revenge upon the butler. Then she bolted. Mrs. Barclay became temporarily insane from an acute attack of brain fever after her husband's sudden death [The Crooked Man). All these disturbances were diseases of the mind due to shock and could not be attributed to primary disease of the brain. But psychology was in its infancy in Watson's day. Even Ur. Trevelyan, who had written a monograph on obscure nervous lesions (The Resident Patient), was deceived by simulated catalepsy in a criminal who came to consult him. He also intended to try amyl nitrite as a remedy, if the patient had not recovered and disappeared while he was fetching it. This seems curious treatment nowadays, but amyl nitrite and nitroglycerin are mentioned by Osier and others as worthy of trial in epilepsy. Dr. Percy Trevelyan had had some success with it in similar cases?one feels sure he had tried cannabis indica too?and probably had some curious neurological analogy in mind. He might have tried amphetamine to-day. But Sherlock Holmes ' quickly told Watson that the catalepsy was fraudulent. I have done it myself,' he said ; the great man ! Dr. Watson was much travelled and had seen many peoples, and naturally had some acquaintance with tropical diseases. Malaria is mentioned in The Sign of Four which was published early in 1890. Jonathan Small was bitten by mosquitos and racked with ague while in the Andaman Islands?a hot-bed of malaria. The theory that mosquitos transmit malaria is as old as Sanscrit according to Garrison, and Manson had proved them vectors of filaria in 1879, although his association of them with malaria is dated 1894 and Ross's proof 1898. Also Major Sholto in the same book had au enlarged spleen and kept a quinine a bottle handy. Watson's association processes were notoriously slow, great blessing to Holmes and his creator, or he might have anticipated Manson and Ross. ' I lie Jaundice in a convict hulk is mentioned in The Gloria Scott. a time is during the Crimean war. It was a rat-infested ship. Surely ^ase of leptospirosis, though we cannot blame Watson for not knowing blew soon this. There was apparently only one case, but as the ship up not time for after the mutiny and most were lost, there was perhaps have had sub-clinical the infection to spread ; or those who escaped may infection. Clearly serological investigation was indicated. Yellow fever caused the death of Mrs. Hebron's first husband in a touch of colour to her Atlanta about 1880. Being a negro he added Hfe and to the story. Atlanta in Georgia is probable, being better known than Atlanta, Texas. There was more than one epidemic in the seventies ?120 GLASGOW MEDICAL JOURNAL in some of the Southern States, severe outbreaks in 1873 and 1878, but as Atlanta stands high, although it was probably in the fever belt, it is likely the disease was caught elsewhere (The Yellow Face). Roger Baskerville also died of yellow fever in Central America in 1870 [The Hound of the Baskervilles). There was hardly a likelier place in which to catch it, unless it was Havana, before Gorgas's time. The most interesting reference to one of the more exotic diseases is, however, in a story written by Holmes {The Blanched Soldier), which contains an account of a leper hospital in South Africa and a good description of the later stages of leprosy. Corporal Emsworth, wounded, manages to reach a house and, lialf-unconscious, enters a sort of ward in the evening and rolls into an empty bed. It becomes clear in the morning that he has spent a night in a leper's bed. L,ater, in England, his in- accessibility to an old friend causes Holmes to be called in and to his being discovered isolated in a doctor's charge in a hut 011 his father's estate. A description of the patchy whiteness of his face is given as it was seen pressed to a window. Holmes, of course, had suspected leprosy and had brought down a specialist who immediately diagnosed the condition as ichthyosis, to everybody's joy. Watson had nothing to do with this case or he would surely have disagreed, and one wonders at Dr. Kent who was in charge. The condition must have been vitiligo or ' leucodermia, sometime known as white leprosy '?disfiguring but harmless. Sequeira says that sometimes it may arise after a shock and it must have been a considerable shock to the corporal to wake up surrounded by lepers and to realise where he had spent the night. Ichthyosis is inherited, shows itself iu early childhood, and is not like leprosy. It is convenient here to refer to the singular happenings in the only other story recounted by Holmes {The Lion's Mane). A man, who already had a damaged heart, died in agony with his skin covered with erythe- matous wheals after bathing in the English Channel. A dog which had followed its master to the water edge was found dead. Another man did not die, but exhibited a similar skin condition after bathing, together with great pain and constitutional disturbance. A blue jelly fish, Cyanea capillata, was the murderer. It is well known that small specimens of this medusa can cause discomfort to thin-skinned bathers. Larger ones -?and some five feet or more in diameter with stinging tentacles a hundred feet long have been described?evidently can cause death. In addition to urticarial erythema and pain, local and general, there may be muscular spasm, feeling of constriction in the chest and difficult respiration. Byam and Archibald give the autopsy findings in a fatal case due to a similar medusa, Physalia ftelagica (Portuguese man o' war), as intense congestion of vessels of the meninges and brain and engorgement of the MEDICAL MATTERS- CARTEK 421 right ventricle. Unfortunately, we have not the benefit of Watson's notes on this case, but Holmes chronicled the adventure very dramati- cally. No one can penetrate far along the sinister paths of crime and thriller fiction without encountering mysterious poisons and noxious drugs which kill or temporarily incapacitate their victims according to the taste and fancy of the writers. In this line of country we are not disappointed in the Holmes stories, where drugs are frequently mentioned. Watson must have learnt a good deal from Holmes on this subject, for the latter's knowledge of chemistry was profound (A Study in Scarlet). Morphia was injected by Watson when Baron Gruner was badly burnt by vitriol (The Illustrious Client), and when Professor Presbury in his ape mani- festations was badly bitten in the throat by his dog (The Creeping Man). Hypodermic injections were certainly being increasingly used in medicine from the eighteen-eighties onwards, when these stories were written ; and Holmes used a syringe for his cocaine, before 1888. Powdered opium was used in curry, which would disguise its bitter taste, to drug the stable-boy (Silver Blaze). The Tiger of San Pedro, Juan Murillo, drugged his governess when he carried her off, and Watson recognised the effects of opium by the small pupils (Wisteria Lodge). An opium den by the river East of London Bridge is described in The Man with the Twisted Lip, and in this story Watson notes the yellow, pasty face, the ptosis of the eyelids and the pin-point pupils of Ira Whitney, who doped his tobacco after reading De Quincey and had gradually become a confirmed addict. Everyone knows about Holmes' use of cocaine as a sedative during idle periods when lie was without a case. No doubt it produced a sense of calm and happiness when the engine of that active brain was running free and ungeared to a mystery. The habit was certainly contracted before 1888 (The Sign of Four), and it is mentioned cursorily in A Scandal in Bohemia and The Man with the Twisted Lip, cases dated 1888 and 1889. Hiere is apparently no later reference to it until 1897 (The Devil's Toot), when it reacted on his health and Holmes took a holiday at the insistence ?f Dr. Moore Agar, of Harley Street, probably briefed by Watson, who had given good advice from time to time. At one time Holmes injected tolerance cocaine in 7 per cent solution thrice daily, and as he acquired must have exceeded the normal maximum dose. However, although it is likely he began to use cocaine in the hope that it would enable him to endure fatigue as preparations of Coca were so used in ancient Mexico and Peru, he may be admired for the strength of mind which prevented ais yielding entirety to its pernicious influence. It is probable that he occasionally used morphine (The Sign of Four). Belladonna, used for its mydriatic properties, helped Holmes to simulate a rare tropical fever (The Dying Detective). Aided by an artificial 422 GLASGOW MEDICAL JOURNAL hectic flush and manufactured sordes, three days' abstention from food, and good acting, he managed to deceive Watson, but only because he was able to keep him at arm's length in a subdued light. Holmes' capacity to go without food was notable, but he was something of a gourmet in the best sense at times, and at the conclusion of this exploit he wisely chose Simpson's for a solid meal. The nature of the poison taken by Professor Coram's wife (The Golden Pince-Nez) before Holmes revealed her hiding place and forced her to rush out is uncertain. She had time to make confession before her face changed colour, and she had to sit down. She continued in impassioned speech, even rising again momentarily, but fell back in pain. She went 011 speaking urgently and eloquently for a minute or two, obviously in pain, before falling back finally. We are not told how she died, but her face contracted as she spoke. Both coniine and strychnine might have given her time for what she did, but there is 110 definite indication of terminal convulsions which strychnine and possibly coniine would have caused. In The Sign of Four one of the Sholtos is killed with a poisoned dart and risus sardonicus is noted together with extreme muscular contraction. The arrow poison must have contained one of the convulsant alkaloids as most of them do, although they are complicated concoctions prepared ' ' with much ritual like the South American wourali poison described by Waterton. In this case the poison probably came from the Andaman Islands. Curare may have been a constituent. I11 the Sussex Vampire both the child and the dog were pricked with a South American arrow dipped in poison. Curare is mentioned by name. In the case of the boy the poison was sucked out by his mother, but the spaniel showed paresis of its hind legs and the complaint was diagnosed by the vet. as spinal meningitis. Holmes spotted the limping experi- mental dog and divined the true cause which led him to solve the problem successfully. The nature of the poison pills with which Jefferson Hope killed Drebber (The Sign of Four) is not clear. A sick terrier was given one and with a convulsive shiver died as if struck by lightning. The speed with which crime-story poisons act is often phenomenal. Hope had stolen the poison from a South American laboratory where he had worked. It was an alkaloid extracted from arrow poision. This suggests curare again, but curare is harmless when swallowed and is only poisonous if introduced directly into the blood stream. Holmes suspected poison by the sour odour of the dead man's mouth. No doubt Watson pandered a little to the public taste and blurred the real picture in satisfying the demand for strong poison. The deliriant and hallucinatory symptoms produced by inhaling the fumes from a burning powder supposed to be used by African medicine MEDICAL MATTERS?CARTER 423 men in trial by ordeal [The Devil's Foot) suggests something akin to hashish, which is capable of producing intense cortical stimulation. The substance was the powdered root?radix pedis diaboli?but the active hemp principle resides chiefly in the flowers and fruiting tops of the plant. There may have been cannabis in this powder ; it killed Brenda Tregennis and left her two brothers raving lunatics. Watson must have exercised a little licence and considerable imagination in this story. He describes vividly the brain-blasting properties of the drug on himself and Holmes when they experimented with it. Prussic acid is mentioned in The Veiled Lodger, but fortunately was not used by the lady whose beauty had been so atrociously marred by a stroke from a lion's paw in an affair of passion with a lion-tamer. Chloroform is used several times. Holmes himself used it to put von Bork out of action in His Last Bow. Thieves chloroformed Mrs. Maberly when they broke into her house (The Three Gables), but they hardly gave her enough, for she recovered while they were at work and raised an alarm. It is employed murderously in an attempt to kill L,ady Frances Carfax (The Disappearance of Lady Frances Carfax), a device which Holmes said was new to him. This lady was anaesthetised, placed in a coffin with her head smothered in cotton wool soaked in chloroform, and the lid was screwed down. Holmes and Watson met it being carried from the house and were just in time. The coffin was made for two so there would be more air than usual, which would account perhaps for Watson being able to revive her with artificial respiration and other devices, among which was the curious one of an injection of ether. The skin of the lady's face must have been burnt, and Holmes certainly taxed her heart when he quickly raised her to a sitting position while she was unconscious in the coffin. Indeed she was lucky to survive the adventure. Gas was used by Josiah Amberley to murder his wife and her lover 0he Retired Colourman), and he tried to commit suicide by swallowing a white pellet, which might have been cyanide. Carbon-monoxide from charcoal fumes was responsible for one death in The Greek Interpreter, ajid the other victim was only saved by Watson's promptness in the emergency ; cyanosed and unconscious, with congested faces and bulging eyes they were dragged out into fresh air. The Greek interpreter recovered after an hour's work by Watson and the help of ammonia and the ubiquitous brandy. He recovered rather quickly all the same. Besides all these references in the stories which may be grouped under the heading of general medicine, there are many allusions to special subjects and to ancillary sciences. A geneticist might be interested in s?me of the instances of inherited peculiarities to which attention is the drawn. There was a queer strain running through Baskervillle family and Holmes had something to say about ears both in 7 he Card- board Box and in the Anthropological Journal. There were also Holmes 424 GLASGOW MEDICAL JOURNAL himself and his brother Mycroft, who both had the deductive faculty greatly developed. In The Yellow Face there are some remarks on atavistic inheritance. Even Watson's ancestry provides food for specu- lation. Many times in these chronicles of crime circumstances arise in which the influence of heredity can be seen in qualities displayed by the actors in the drama. Professor Moriartv is an interesting subject for ' ' a psychiatrist, for that Napoleon of crime was surely a paranoiac, or at anyrate possessed in high degree the paranoid temperament which is the common factor in anti-social persons. Moriarty had all the mega- lomaniac propensities of the exalted egocentric, and very nearly ' ' liquidated Holmes who interfered sadly with his nefarious projects [The Final Problem). A most absorbing study which runs through all the stories and forms a chief function in Holmes' remarkable deductive reasoning lies in the byways of anatomy?his knowledge of which Watson said was good but unsystematic?in which he had pursued clues to human occupation, character and behaviour based on changes or anomalies in bodily anatomy. This represents, as is well known, Conau Doyle's adaptation of the methods of observation and analysis of Dr. Joseph Bell of Edinburgh almost seventy years ago in the days of Doyle's studentship. Holmes was so interested that early in his career he had written a monograph on the effects of occupation on the hand. His powers of observation of minute details and his highly developed faculty of deductive reasoning which enabled him to relate them to probable facts produced the remarkable description of Henry Baker from an investigation of his old hat (The Blue Carbuncle) ; of Dr. Mortimer from an inspection of his walking-stick (The Hound of the Baskervilles) ; of Grant Munro from a consideration of his pipe (The Yellow Face) ; and of Watson's brother from an examination of his watch (The Sign of Four). At its best this faculty, so astounding to Watson and to those on whom it was exercised, is displayed in the amazing conver- sational duel between Sherlock and Mycroft at the Diogenes Club (The Greek Interpreter). Even anthropology was not outside Holmes' range, for he discussed skulls with I)r. Mortimer, who was an expert (The Hound of the Basker- villes). And did he not investigate the coal-tar derivatives at Montpelier (The Empty House), and work 011 the acetones (The Copper Beeches), and discover in his youth that delicate test for haemoglobin, details of which he never revealed, which was to replace the old guaiac test ? (A Stud)' in Scarlet).

Much more of interest than is written here can be extracted from the stories by the inquisitive medical reader. There is Watson's curious appreciation of strychnine in large doses as a sedative ; a grim joke for MEDICAL MATTERS?CARTER 425 the solid figure whose function is so rarely to see the point until it is explained to him, but there were good reasons for his apparent lapse. Then there is the unforgettable sketch of the hypochondriac who could rely upon his aortic valve but begged for Watson's opinion on the mitral. Watson obliged [The Sign of Four). Very rarely are medical references in Watson's reconstructions of Holmes' cases obviously forced or built on to the narrative. They occur naturally in their places amidst the flow of crisp epigrammatic dialogue, as the inevitable running commen- tary upon events as they occur, because these are described by a doctor and seen through his eyes. The blending is so skilful that for the lay reader they rarely interrupt the brilliant story-telling. The interchanges between Holmes and Watson are full of good things, and the Sherlock Holmes canon has enriched literature with more than a few aphorisms due to this immortal partnership between a detective and a doctor. Holmes and Watson are the only characters in the stories ; the rest are puppets who dance to their fiddling. Few people, as Chesterton put it, could say whether Mrs. Watson was dark or fair, and perhaps only the true devotee knows that Holmes' eyes were grey, which is mentioned only once, like the name of Bill Sikes' dog ; and that Watson played rugger for Blackheath and studied medicine at Bart.'s, that nursery of literary physicians. But Sherlock Holmes and Dr. Watson are as well known as the great Dickens characters. They are more than figures in a book, they are the epitome of an age, the spirit of the town at the turn of the century. Their gas-lit London has gone, and the Strand magazine is not what it was when Watson was a contributor, in the days when there was gusto in life and letters ; when the lights were up at the old Gaiety, and there was Norman Neruda at the Halle concerts and the ' ' ?ld Pink 'Un came out on Friday. There are ghosts in Baker Street; Wraiths of a tall, gaunt figure and his solid shouldered companion. If you understand the ghostly language, you may hear, like an echo from His Last Bow, as they shimmer in the heated air over London in some ' later August:?' The wind is still in the East, Watson.' I think not, Holmes, it is very warm.' The hero in Henry Arthur Jones's The Silver King exhorts his God t? put back the universe and give him yesterday. What yesterday could Baker be more excitingly spent than in an early call at the old rooms in or Street, followed by a jaunt with Holmes and Watson through London of into the country from Paddington or Waterloo on the scent something new in the annals of crime ? Pleasant it would be to hear Holmes demon- strate the singularly elementary nature of the apparently obscure problem, and to end the day, if the gods were propitious, with a call on brother Mycroft, at the Diogenes Club?in Pall Mall?not far from the Carlton. Eheu fugaces ! 426 GLASGOW MEDICAL JOURNAL

REFERENCES.

Byam, W. & Archibald, R. G. (Fdit.) (1922). The Practice of Medicine in the Tropics. London : Frowde & Holder & Stongliton. Doyle, A Conan (1928). Sherlock Holmes?The Complete Short Stories. London: John Murray. Doyle, A Conan (1929). Sherlock Holmes?The Complete Long Stories. London : John Murray. Garrison, F. H. (1917). History of Medicine (2nd edn.). Philadelphia and London : W. B. Saunders & Co. Osier, W. (1925). Principles and Practice of Medicine (10 th edn.). London: D. Apple ton & Co. Sequeira, J. H. (1927). Diseases of the Skin (4th edn.). London : J. & A. Churchill.