From the Stethoscope to the Magnifying Glass: Sherlock Holmes and Medicine in Late 19th Century Britain


 

Basil Kahwash,

Resident Physician, Internal Medicine Residency Program, Indiana University School of Medicine

 

 

Abstract

Prior to creating Sherlock Holmes and devoting his career to writing mystery fiction, Sir Arthur Conan Doyle was a trained physician who received his education at a pivotal time in Western medicine - one that saw the refinement of diagnostic reasoning as an art. Doyle’s prowess as an author is intertwined with his past as a physician, which served as his primary literary inspiration. Here we trace the origins of the character Sherlock Holmes, and with them the origin of mystery as a mainstream literary genre, to Doyle’s time as a medical student at the University of Edinburgh, with particular attention to key contacts he made.

 

Keywords: Medicine, Britain, Literature, Mystery

 

Introduction

The character Sherlock Holmes, perhaps the most iconic figure in all of mystery fiction, was first introduced in A Study in Scarlet, a short story by Sir Arthur Conan Doyle. Beginners in creative writing are often advised to “write what you know” – which may explain why Doyle, a physician by training and trade, cast a medical doctor, John Watson, as the narrator of his story. Indeed, Watson starts off the story by introducing himself as a man who “took his degree of Doctor of Medicine” from the University of London. (1) But Sherlock Holmes stories are crime-solving adventures – where did the author get the experience to describe a detective’s mind so convincingly that his principal character would become a literary legend for generations? By his own admission, that very same medical training played a major part. (2) Doyle, having been educated in the flourishing science of diagnostic medical reasoning in Victorian Britain, created Holmes to apply a clinical mind to criminal investigation. The author’s close familiarity with the medical profession inspired him to create the beloved character Sherlock Holmes, and thus transformed mystery fiction, as we know it. 



Crime-solving fiction first emerged in Western literature in the mid-1800s, following the introduction of institutionalized police forces. Townships that were now emboldened to address the issue of crime became increasingly dissatisfied with unsolved crimes and demanded a new breed of officer who could resolve them: the detectives. Gradually, fictional detectives found a literary audience. Perhaps the best-known pre-Doyle mystery story is Edgar Allen Poe’s The Murders in the Rue Morgue, published in 1841. The protagonist of that story (as well as a few other Poe works to follow), Auguste C. Dupin, is widely acknowledged to be the first fictional detective. Poe compares Dupin’s reasoning to that of a master poker player. Dupin’s style involves reading a person’s expressions for signs of an underlying emotion that may lead to information about a crime: “He notes every variation of face as the [card] game progresses…embarrassment, hesitation, eagerness, trepidation – all afford, to his apparently intuitive perception, indications of the true state of affairs.” (3) What distinguishes Doyle’s signature character Sherlock Holmes from previous literary detectives is his unique talent for observation of physical signs – such as a misplaced garment or an unexplained bruise. Until Sherlock Holmes was introduced in 1887, mystery reading remained an esoteric pastime. Upon the debut of Holmes, mystery fiction’s popularity increased exponentially. Doyle’s medical training inspired him to broaden the observational talents of the literary detective, which was key to the eventual flourishing of the mystery genre.


A Golden Age of Observation

In order to understand the creative origin of Sherlock Holmes, one must first consider the role of diagnostic reasoning in the medical profession during the Victorian Era. Europe during the mid to late nineteenth century has been touted as a golden age for clinical observation in medicine. By contrast, progress in therapeutics occurred slowly. Most medical therapies of that time period were crude and ineffective. Drug discovery and testing was in its infancy, and an immature understanding of microbes and antisepsis made surgical treatment risky. The American physician and poet Oliver Wendell Holmes, Sr. wrote in 1860, “throw out a few specifics”, namely opium and anesthetic gasses, “…and I firmly believe that if the whole material medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind.” (4) Thus physicians of the time period, while becoming more accurate in their reasoning, were still limited in their ability to combat illness. 


Frustrated by stagnation in therapeutic discoveries, many Victorian-era physicians turned to the science of observation and the art of diagnosis for progress. (5) Physicians of Doyle’s time did not have the luxuries of imaging and sophisticated clinical lab tests that are afforded to twenty-first century doctors. As a result, they relied almost entirely on the patient’s story and whatever they could gather from close physical examination of the patient. To be a great physician at that time required being perceptive of seemingly innocuous details and, as good doctors continue to do presently, weaving all of the information together into a pattern that suggests a specific disease process. Physician trainees were groomed to ask poignant, inspective questions when interviewing the sick. They were also expected to gather knowledge about a patient using the senses, including smell and taste. This time period saw widespread adoption of the stethoscope (invented in 1816), ophthalmoscope (1851), and laryngoscope (1854), all of which elucidated greater details about the physical state of the patient than had ever been possible before. (4) In the midst of a medical culture that celebrated observation, a young Doyle enrolled in the MD program at the University of Edinburgh. His hometown university, Edinburgh was at the time renowned as one of the premier medical institutions in Europe and the world. (6)


From Doctor to Inspector

Doyle was by his own admission an average medical student, possibly because he pursued education in other subjects concurrently (he began writing his first Sherlock Holmes story while a student). Nevertheless he was firmly entrenched in the academic medical world of his university. During his time at the University of Edinburgh, Doyle was mentored by Dr. Joseph Bell, a clinical professor of medicine and surgery who would later serve as the main inspiration for Sherlock Holmes. (6) Dr. Bell was a master of observation in a time when diagnostic ability was prized above all other medical skills. Indeed, Doyle would later relate that his encounters with Bell changed how he thought about diagnosis in a way that would ultimately lead him to create Sherlock Holmes. If Bell’s methods of clinical reasoning could lead to such precision in solving medical riddles, could a detective use them to confront unsolved crimes? Doyle reflected, “I thought I would try my hand at writing a story where the hero would treat crime as Dr. Bell treated disease.” He added of Bell, who incidentally was known to sport a cap similar to the one Sherlock is usually depicted wearing, “he would often learn more about the patient from a few quick glances than I had done by my questions.” (6) When Sir Arthur Conan Doyle embarked on a literary quest to extend medical reasoning to criminology, the character Sherlock Holmes was the natural product. 


The similarity between the fictional detective and Dr. Bell is most evident in the reader’s very first introduction to Holmes, in A Study in Scarlet. Sherlock takes one glance at John Watson, his future flat-mate and partner in crime-solving, and that is enough to decipher major details about Watson’s past. He concludes first by his appearance that Watson must have recently returned to England from Afghanistan, and asks him how long ago he left that country. Puzzled as to how Holmes could have known about such an event, Watson presses him to explain his reasoning. Holmes confidently responds with an analysis of Watson’s clothing and body language. Specifically, he notes Watson’s gentlemanly appearance and apparent high level of discipline; these factors suggest to Holmes that Watson works as a military doctor.  He then observes the unnatural “tint of [Watson’s] skin” considering his dark face but fair wrists. Holmes detects “hardship and sickness” from Watson’s haggard face and finally concludes, “Where in the tropics could an English army doctor have seen much hardship and got his arm wounded? Clearly in Afghanistan.” (1) Combining these astute observations and contextual clues, Holmes unravels Watson’s recent activities. 


Holmes’s introduction to Watson bears striking similarity to an account of Dr. Bell’s clinic around the time Doyle was a student. Bell, accompanied by several students, went to see a patient. Before the patient had said more than a few words Dr. Bell surmised that he was a Scottish officer in the Army who had recently returned from serving in Barbados. The medical students were in awe of their professor. Bell casually explained his thought process “You see, gentlemen, the patient is a respectful man, but did not remove his hat”, noting that army men typically did not. However, Bell pointed out, had the man been out of the army for long he would have “learned civilian ways” – meaning that he must have been recently discharged. Bell picked up an “air of authority” from the man, which indicated high rank, as well as a Scottish accent. As to Barbados, Bell observed that the man was seeking medical help for “elephantitis, which is West Indian and not British.” (7) Bell combines his own knowledge of cultural habits with an attention to detail in order to draw conclusions about a person’s background. It is clear by comparing these two accounts that Sherlock Holmes’s manner of logic reflected that of Doyle’s mentor, Dr. Bell.

 

 

Mystery’s Heritage in Medicine

Evidence of a medical footprint in the Sherlock Holmes canon abounds. In an apparent homage to his intellectual heritage, Doyle incorporated medicine both subtly and explicitly in numerous scenes of his work. In Sherlock Holmes’s first appearance in A Study in Scarlet, the detective is at work on a new method of staining blood – something with overlapping applications in both forensics and medicine. In The Dying Detective, a tropical infectious disease is implicated as the technique of a murder. (8) Having trained in ophthalmology, Doyle made reference to the medical specialty in several of his mysteries. In the Sherlock Holmes story The Adventure of Silver Blaze, for instance, a “cataract knife” is used as a weapon; in The Adventure of the Golden Pince-Nez, Holmes describes a woman without having seen her based on her eyeglasses alone. (9) Doyle’s experience in medicine is firmly embedded in his stories.


Virtually all major mystery writers since Doyle would later trace some of their literary inspiration back to Sherlock Holmes. The legendary author Agatha Christie openly acknowledged Holmes as an influence when she created her protagonist detective, Hercule Poirot, early in the twentieth century. Mystery literature since Sherlock Holmes has borne his mark, and thus the legacy of Victorian Era medicine from which he came. (10) 


Doyle’s legacy did not go unnoticed by writers of medical fiction. Nearly sixty years after his death, another physician-writer, Michael Crichton, paid tribute to the late author by naming the sequel to his best-selling Jurassic Park The Lost World”, after Doyle’s 1912 novel of the same name. Even more recently, the creator of the 2000s TV program House, MD acknowledged that Sherlock Holmes stories inspired him to write a show about a physician with a talent for reasoning and a keen eye. (11) Thus, Holmes’s qualities were reverse engineered to create a program about the medical prototype from which the character was originally born. In a sense the Sherlock Holmes legend was brought full-circle.


Conclusion

The character Sherlock Holmes was inspired by his author’s extensive experience in the medical field. Holmes as a character permanently transformed mystery fiction and is responsible for bringing it into the mainstream. To Arthur Conan Doyle, the character represented the extension of his experience as a physician to his diverse interests in the fields of criminology, culture, and politics. Sherlock Holmes embodies great minds of the profession during a decisive time in the evolution of clinical reasoning. Sherlock Holmes’s defining feature, his analytic prowess, derives from Doyle’s experience as a curious medical student interested in criminology, made possible by the growth of medical observation and reasoning in the late nineteenth century.

 


Acknowledgments

The author would like to acknowledge Dr. James Ravin for his guidance on this topic as well as Mr. John Runge for valuable feedback.

 


References

1. Doyle, Arthur Conan. The Complete Sherlock Holmes. New York: Barnes & Noble Classics, 2003.

2. Booth, Martin. The Doctor and the Detective: a Biography of Sir Arthur Conan Doyle. New York: Thomas Dunne, 2000.

3. Poe, Edgar Allen. Tales of Mystery and Imagination. London: CRW Publishing, 2003.

4. Porter, Roy. Blood and Guts: A Short History of Medicine. New York: W.W. Norton & Company, 2003.

5. Peterson, M. Jeanne. The Medical Profession in Mid-Victorian London. Berkeley, Los Angeles, London: U of California P, 1978.

6. Peschel RE, Peschel E. “What Physicians Have in Common with Sherlock Holmes.” Journal of the Royal Society Medicine. 1989. 82: 33-36.

7. Snyder LJ. “Sherlock Holmes: Scientific Detective.” Endeavor. 2004. 28: 104-108.

8. Sodeman WA. “Sherlock Holmes and Tropical Medicine: a Centennial Appraisal.” Am J Trop Med Hyg. 1994. 50(1): 99-101.

9. Ravin JG, Migdal C. “Sir Arthur Conan Doyle: the Author Was an Ophthalmologist.” Surv Ophthalmol. 1995. 40: 237-244.

10. Youngson, A.J. The Scientific Revolution in Victorian Medicine. New York: Holmes and Meier, 1979.

11. Pasha, Adam. “Reflecting on House with Creator David Shore” [HTML]. 9 October 2012 [2 May 2014]. Available from: http://www.huffingtonpost.com/pasha-adam/house-david-shore_b_1942525.html.

 

Basil Kahwash is a first-year Internal Medicine resident at Indiana University, with a scholarly interest in the history of medicine. He can be reached at bkahwash@iu.edu.

 


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Historia Medicinae Editor,
Aug 14, 2015, 1:52 PM
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