A doctor enjoys Sherlock Holmes

Dr. Watson professed to be a general practitioner of medicine. Such a person is called upon from time to time to do minor, but under ordinary conditions he does not attempt to do major, surgery. To my knowledge, there is no particular reference to major surgery in any of the tales, although one or two famous surgeons are mentioned. On the other hand, numerous allusions are made to minor surgery. I am cognizant of the fact that there is often but a thin line between major and minor surgery.

Dr. Watson evidently felt that a good surgeon must have large and supple hands, for he writes: “... the thin white hand he laid on the mantelpiece ... was that of an artist rather than a surgeon” (The Resident Patient). The size of the hand probably is not of major importance. It is the ability to use the hands that counts. Several eminent surgeons, to my own knowledge, are men of large physical stature, and I am sure have correspondingly large hands. But I have seen some equally capable men, hardly of average height, who had small hands. Harvey Cushing, the brilliant Harvard brain surgeon, was a man of medium size, and, if I recall correctly, had rather small hands. Let us not labor this point further, for this is not an essay on surgeons’ hands, but turn to the tales of Sherlock Holmes.

It is axiomatic that every man who practices medicine, regardless of his specialty, must be familiar with the current literature in his field. It is gratifying that Dr. Watson appreciated this. In The Adventure of the Golden Pince-Nez, Watson observes that one stormy night he and Holmes sat together in silence; the latter was working on a palimpsest, while Watson was reading a treatise on surgery.

Holmes appreciated that a correct diagnosis is of paramount importance to a conscientious surgeon. In The Problem of Thor Bridge, we find Mr. Neil Gibson, the “Gold King,” telling Holmes that he was like a surgeon, because Holmes wanted to know every symptom before he ventured a diagnosis. Holmes quickly retorted that this was quite true, and strongly implied that his client was withholding important information which Holmes needed before the mystery about which he was being consulted could be solved.

There are a number of references to scalp wounds or injuries to the skull, or both. In the rough-and-tumble life a detective leads, it might be expected that he would often see such injuries. Let us examine some of them.

Once Sherlock Holmes himself came under a surgeon’s care. The great detective had been attacked on the street by two ruffians and had been pretty roughly handled (The Adventure of the Illustrious Client). Sir Leslie Oakshot, the eminent London surgeon who had been called in, stated that Holmes had suffered lacerations of the scalp and that several stitches were necessary. Holmes fortunately made an uneventful recovery, and we learn that the stitches were taken out on the seventh day.

Dr. Watson describes a man in The Adventure of the Solitary Cyclist who had suffered a severe scalp wound. He had been found unconscious, although the bones of the skull had not been penetrated. Another case is mentioned which surely must puzzle the layman (The Adventure of the Dancing Men). A bullet passed through the frontal portion of the brain. The reader is assured that, although the patient was unconscious, she would live. The medically trained person would think immediately of an accidental lobotomy.

One is reminded in this connection of the skull of a workman exhibited in the museum of the Harvard Medical School. This rare specimen shows an enormous hole made by a tamping bar. The bar passed through the skull, and a considerable amount of brain substance was destroyed. Remarkably enough, the patient did not die from this terrific injury, but lived for a long time afterward—surely a most unusual case. It should be added that he suffered an unfortunate change in his personality following the accident.

In several instances, the head injuries mentioned were immediately fatal. For example, in The Adventure of the Empty House, an expanding revolver bullet was fired into the victim’s head. In The Boscombe Valley Mystery, we find that: “The head had been beaten in by repeated blows of some heavy and blunt weapon.” In this last story, Dr. Watson gets technical: “In the surgeon’s deposition it was stated that the posterior third of the left parietal bone and the left half of the occipital bone had been shattered by a heavy blow from a blunt weapon.” But contrast the following nontechnical description: “The injury from which the unfortunate veteran was suffering was found to be a jagged cut some two inches long at the back part of his head, which had evidently been caused by a violent blow from a blunt weapon” (The Crooked Man). This is a good example of a wound so simply described that anyone could easily understand and appreciate it. With few exceptions, Watson never forgot that he was writing for laymen.

Scalp wounds and injuries to the head are often used to dramatize detective stories. The average layman instinctively feels that such wounds are extraordinarily dangerous, and that people experiencing such accidents are nearly always in a critical state. This, of course, may or may not be true, because nature has provided a strong bony cage to protect the brain.

In The Adventure of the Sussex Vampire, there occurs a reference concerning an orthopedic problem. Dr. Watson writes that the gait of a fifteen-year-old boy suggested plainly that he had a weak spine. We are further informed that a fall in childhood had brought about this condition. The devoted father spoke of the lad as being an unfortunate cripple and quite inoffensive. He was quite mistaken, for this so-called inoffensive lad became so insanely jealous of his normal, healthy baby half-brother that he tried to do away with him by use of curare, the South American Indian arrow poison. When Holmes unearthed this diabolic scheme, he reluctantly informed the boy’s unsuspecting father. Holmes prefaced his remarks by stating that he was a busy man and would come to the point quickly; and he used the simile that, the swifter surgery is done, the less painful it is.

The idea Holmes expressed in regard to swift surgery holds our interest. In the early days, before the discovery of ether, surgeons for obvious reasons attempted to perform operations in the shortest possible time. Indeed, the skill of a surgeon was largely gauged by the speed with which he could perform an operation.

In at least two of the tales, the carotid artery was the focal point of interest. In The Adventure of the Creeping Man, we find that when Professor Presbury was viciously attacked by his wolfhound, the teeth of the dog narrowly missed the carotid artery. In spite of the rather severe hemorrhage which followed, it will be recalled that the professor recovered. In The Adventure of the Golden Pince-Nez, the victim was not as lucky. His carotid had been severed by an old-fashioned sealing-wax knife, and death ensued in a short time. Watson emphasized that the wound was small but deep. He was aware that a large blunt instrument might have pushed the elastic artery aside rather than piercing it.

We find one reference to an amputation, although it was not performed by a surgeon. Early one morning, there appeared in Dr. Watson’s consultation room a young engineer who, during the preceding night, had undergone a harrowing experience in which his thumb had been hacked off by a vicious counterfeiter. The doctor was astounded when he saw the wound: “It gave even my hardened nerves a shudder to look at it. There were four protruding fingers and a horrid, red, spongy surface where the thumb should have been. It had been hacked or torn right from the roots” (The Adventure of the Engineer’s Thumb).

When Dr. Watson asked the victim whether the wound had bled a great deal, the answer was: “Yes, it did.... I tied one end of my handkerchief very tightly around the wrist and braced it up with a twig.” Watson’s succinct reply was: “Excellent. You should have been a surgeon.” To satisfy the reader’s sympathetic curiosity, it should be mentioned that Dr. Watson gave the patient a drink of brandy, and cleansed and bandaged the wound. Since the thumb had been “torn right out from the roots,” it seems that Dr. Watson should have taken a few stitches to bring the cut tissues together. No such mention is made, and it is to be hoped that the wound healed satisfactorily.

It is noteworthy that this engineer must have had a rugged constitution. Dr. Watson, after caring for the wound, took him to 221B Baker Street, where he joined Holmes and Watson in eating a substantial breakfast. Then, for the benefit of the consulting detective, he related the night’s terrible adventure at some length. He next accompanied Holmes and his companions on a train journey to Eyeford, a little Berkshire village. This was a strenuous program. The question arises, why did the kind Watson allow his patient to do all these things? This young man should have received a narcotic to deaden the pain, which must have been severe, and then should have gone to bed. If the patient experienced difficulty in going to sleep, a hypnotic should have been administered. In this instance, Dr. Watson placed himself in an indefensible position.

Let us now turn from injuries of the human flesh and consider something relatively less gruesome. A surgical instrument is described and, interestingly enough, the name of the manufacturer is given. Holmes himself calls our attention to it: “... an ivory-handled knife with a very delicate, inflexible blade marked Weiss & Co., London” (Silver Blaze). Parenthetically, it should be stated that Weiss & Co., are still famous makers of knives. Indeed, there are several in my laboratory at the present time.

When Holmes speaks of the singularity of this knife, and suggests to Dr. Watson that surely this was in his line, the latter states, “It is what we call a cataract knife.” Holmes replies, “A very delicate blade devised for very delicate work.” The reader should be reminded that the knife in question was not employed to murder a human being, but a villainous horse trainer had intended to use it to cut the tendon of a famous race horse. It will be remembered that the nefarious scheme was never carried out, for the highly nervous thoroughbred animal killed his trainer by kicking him on the head before the operation could be performed.

As far as I am aware, Watson did not make any specific mention of any other surgical instruments in the tales. He does, however, on one occasion make an allusion to a surgeon’s choice of his instrument during an operation. He is commenting on Holmes’ selection of tools when attempting to open the safe of the notorious blackmailer, Charles Augustus Milverton, and points out that Holmes chose his instruments with the same scientific precision as a surgeon about to perform an important operation (The Adventure of Charles Augustus Milverton).

In the present essay, we have discussed only those cases which are concerned with surgery. But in England the medical man is often spoken of as a “surgeon,” rather than a physician or a doctor or a general practitioner. We find such expressions in the Sherlock Holmes stories: “And here comes the country surgeon ...” (The Adventure of the Copper Beeches). Numerous other references could be cited, but this one will suffice. Furthermore, a doctor’s treatment room is spoken of as his “surgery.” This latter expression is often found, especially in English novels. The villain Stapleton, in The Hound of the Baskervilles, tells Dr. Watson that he had been visiting with Dr. Mortimer, and that while they were in his “surgery,” Dr. Mortimer had pointed out Dr. Watson through the window. In another instance, we find, “The surgery, where I used to make up my drugs ...” (The Sign of the Four). In this country, we would simply call it “the doctor’s office,” or if we wanted to be more specific, his “treatment” or “examining room.” These are minor differences, it is true, but they are of passing interest.

Some of the wounds so dramatically described by Dr. Watson surely became severely infected, and the patient’s suffering must have been considerable. Pasteur and Lister had already published the results of their brilliant researches, and the medical profession was well aware of the dangers of infections at the time. In spite of this, not much could be done once the wounds began to suppurate, for the antibiotics had as yet not been discovered. We may rest assured, however, that Dr. Watson did all he could to alleviate the patient’s pain and to promote healing of the wound.