Medical Matters in the Sherlock Holmes Stories From, the Records of John H

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.

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