A doctor enjoys Sherlock Holmes

Since I am a professional physiologist, references made to physiologic matters in the tales are of especial interest to me. Physiology, as the term is now used, may be defined as the science which deals with the function of an organism and its parts, in contrast with anatomy, which is concerned only with the structure of an organism.

Dr. Watson took his work at the University of London Medical School, and was graduated in 1878—eighty years ago. We may assume that he received good training in physiology; at any rate, he apparently had a healthy respect for this important science. Let us examine the references he makes to physiologic matters in the tales.

Physiologists

In The Adventure of the Creeping Man, a physiologist, Professor Presbury, is the central figure. Dr. Watson speaks of him as a renowned “Camford” physiologist. The word “Camford” is a happy choice. It strikes one that it could be a combination of two words, Cambridge and Oxford. Whether Dr. Watson had these two famous schools in mind, I cannot say, but I am inclined to believe he did. It is noteworthy that he depicts Professor Presbury as a wealthy man. On one occasion, Sherlock Holmes and Doctor Watson called at Presbury’s home. The good doctor wrote glowingly about the physiologist’s charming house and beautiful grounds, and emphasized that the professor was surrounded with every sign of luxury.

This is truly an unusual picture, for not many professional physiologists are wealthy, and they certainly are not surrounded with luxury. Professor Presbury, fortunately, was an exception. He must have been a wealthy man in his own right, or have married a woman of means, for surely he did not become wealthy by teaching physiology.

Professor Presbury’s assistant, Mr. Trevor Bennett, is interestingly pictured as a handsome, tall young man, and elegantly dressed. He was portrayed as having the shyness of the student rather than the self-possession of a man of the world. We can readily understand his shyness and his studious manner, but it is more difficult to imagine his elegant appearance. Bennett, we find later, had a medical degree, so perhaps he enjoyed a consulting clinical practice, which might account for his exceptional elegance.

Mr. Bennett’s careful grooming is in contrast to the usual situation, because physiologists, I fear, do not have the reputation for being well-dressed people. They are apt to be somewhat indifferent about their personal appearance, especially when at work in the laboratory. This is quite understandable, since they often work with such animals as cats, dogs, and monkeys, and with even larger animals like sheep, goats, and pigs. Some of the more fastidious scientists don old clothes for such occasions, but this is not always convenient. At any rate, the average physiologist is not known for his elegant appearance—and for good measure, I will throw in the pharmacologists also! Several living examples of each could be cited to prove my point, but I must refrain from embarrassing my distinguished friends and colleagues. At least Mr. Bennett may be considered an exception.

Endocrinology

In the story discussed above, the author uses the theme of endocrinology. Professor Presbury, widower in his early sixties, had fallen madly in love with a very young girl. In his desire to regain his lost youth, the professor administered to himself injections of serum prepared from apes. A conniving Prague scientist had prepared the material from the langur, which Watson dramatically described as one of the higher apes, distinguished by a black face, and an inhabitant of the slopes of the Himalayas.

According to the story, the serum had a profound effect on the professor. Following the serum injections, which he took at nine-day intervals, he acquired the characteristics of an ape, not only by simulating the mode of locomotion of this animal but by developing, also, an uncanny ability to climb.

One night, following a serum injection, the professor got into grave difficulty when his heretofore faithful wolfhound Roy, which he was bedeviling, attacked him viciously. As Sherlock Holmes told Dr. Watson, the wolfhound thought he was attacking the monkey, not his master. Presbury was saved by the quick action of Holmes and Watson.

The plot is fantastic, but interestingly told. Today this story would be regarded as science-fiction. It was written at a time when the subject of rejuvenescence had been made popular by the endocrine studies of Steinach and of Voronoff, the European scientists. The father of endocrinological studies was, of course, Charles-Edouard Brown-Séquard, who had reported his studies on testicular extracts in 1889. Dr. Watson was undoubtedly familiar with Brown-Séquard’s work. In The Adventure of the Creeping Man, Holmes points out a moral when he remarks to Watson that, if one leaves the straight road to destiny, even the highest type man may revert to the animal.

Digestion

Let us turn to the physiology of digestion. Dr. Watson obviously felt that one should eat sparingly if brain work is to be done. We find him saying that his friend Holmes had eaten no breakfast, because in his more intense moments he allowed himself no food. Holmes contended that he did not have energy to spare for both nerve force and digestion (The Adventure of the Norwood Builder). On another occasion, Holmes, when talking to Doctor Watson, emphasized the fact that starvation refines the faculties. He insisted that during digestion the brain is robbed of blood, because blood is needed in the splanchnic area. Holmes insisted that he himself was a brain, and the rest of his body a mere appendix (The Adventure of the Mazarin Stone).

The ideas expressed in the above paragraph hold our physiologic interest because, at the time Watson wrote, the concept he expressed was the accepted one. Later work has shown that this theory is not tenable. The modern view is that digestion does not influence the blood supply to the brain. In point of fact, nature has taken careful precautions to ensure the brain of a rich blood supply at all times under normal physiologic conditions.

Although the brain does not suffer in its blood supply during digestion, it is well known that the body is capable of shunting blood to those regions which are functioning and are, therefore, in need of it. If a hearty meal is eaten, a rich supply of blood is required to digest and absorb it. Athletes know that a large meal should not be eaten before taking strenuous exercise. Indeed, if a substantial amount of food be eaten preceding intense physical exertion, the athlete may become nauseated or even vomit.

The voluntary muscles need blood when functioning, and the greater the amount of exercise, the more blood is needed. The circulatory system cannot supply both the splanchnic region and the skeletal muscles under these conditions, so some part of the body must suffer. The nausea and vomiting are, in a measure at least, produced by anemia of the stomach. In the example just given, there is also a nervous component, which in some individuals plays an extremely important part.

Let us return to the blood supply of the brain. There is some evidence that the brain needs a slightly increased blood supply during lively mental activity, but not all physiologists will accept these findings. However, this may safely be stated: the metabolism of the brain is high at all times and is not affected by mental work. If one indulges in “heavy thinking,” one simply directs the activities of the nerve cells in the brain, which already are active.

If we accept the hypothesis that increased mental activity does call for slightly more blood to the brain, then the mind actually may be more keen and alert when the circulatory system does not have to sustain the burden of digestion and absorption of food. The fact that there is often a feeling of well-being following a satisfying meal does not negate this concept. There are those who maintain that the mind functions best during a state of moderate fasting. Dr. Watson evidently believed this, as has been previously stated. All physiologists would not agree with this concept. Undoubtedly, there is a wide individual variation in this regard, and it would be unwise to make a sweeping generalization.

A Weaker Sex?

Dr. Watson implies, in The Adventure of the Devil’s Foot, that physiologically the female has a weaker constitution than the male. In this story, it will be recalled that two men and one woman were exposed to the fumes of the powdered devil’s-foot root. Watson stated that only the woman was killed, presumably because she was the more sensitive. This is indeed a challenging statement.

Considerable proof can be adduced to show that the female is hardier than the male. The old cliché, “the weaker sex,” can be seriously questioned. It is well known, for example, that women can withstand a high blood pressure for years. In some instances, although by no means all, it seems to do them but little harm, since in spite of it they may live to a ripe old age. Hypertension in the male is generally a serious condition. Many men die comparatively young from heart failure or from cerebral hemorrhage due to hypertensive states.

Recently, it has been shown that female animals, such as rats, can withstand acute oxygen-want far better than males. I do not wish to belabor the point that the female may be hardier than the male, but two more bits of evidence can be presented. Data compiled by life-insurance companies definitely show that there are more widows in this country than widowers. Lastly, more boy babies die than girl babies.

These arguments seem to prove convincingly that the male and not the female is the weaker sex. The problem, however, is not as simple as this, but space does not permit further critical treatment of the subject. In fairness to Dr. Watson, it must be stated that many of the facts just presented were not known when he wrote his entertaining but gruesome story about the devil’s-foot root.

Mental Development in the Young

We find, in The Adventure of the Sussex Vampire, an interesting and significant reference to mental development in the young. Holmes, speaking of a child, remarked in this story that the child probably had a very well-developed mind, because his body had been circumscribed in action. Obviously, a child who has a definite physical handicap cannot romp and play like other healthy, vigorous children. He is forced to find other outlets, and as a result probably reads a great deal, and is likely, moreover, to be thrown in with older people. As a consequence, his mind presumably is more precociously trained. There are many physically handicapped children, and this entire matter deserves more critical psychologic study than it has so far received.

Curare and Physiology

Dr. Watson was acquainted, at least to a degree, with the action of curare. Actually, he used it as a lethal agent in two of his tales: in his novel A Study in Scarlet, and in his story, The Adventure of the Sussex Vampire. In the former, he was careless of the way he handled curare in his plot, for he ascribed actions to this drug which it simply does not possess. But in the latter instance, he uses curare in a masterly manner. He points out, for example, that if a child were pricked with an arrow which had been dipped in a solution of curare, death might ensue by muscular paralysis if the curare were allowed to be absorbed. Incidentally, this story can be highly recommended not only to physiologists and pharmacologists but to all medical and biological students as well.

It is likely that Watson became familiar with curare in his work in the physiology laboratory, for about twenty years before he enrolled in medical school, Claude Bernard, the famous French physiologist, had published his studies on curare.

Muscle Physiology

Let us now consider references to muscle physiology. Both Sherlock Holmes and Dr. Watson are portrayed as splendid athletes. In The Hound of the Baskervilles, Watson writes about their heroic efforts to save Sir Henry from the awesome hound. He states that he had never seen Holmes run as fast as he did that night. He remarks further that he (Watson) was reckoned fleet of foot, but Holmes easily outpaced him. In physiologic parlance, the muscles of Holmes and Watson presumably had short reflex times. Some men are born fast runners. The exact reason for this is not fully understood. Probably the entire neuromuscular apparatus, including the higher nervous centers, is implicated. Another factor is the mechanical advantage involved in the muscle-bone relationship. All these factors undoubtedly have to do with heredity. The entire picture is complicated. We do know, however, that training alone cannot produce champions.

In another instance, Holmes discusses with Watson the footprints found in the yew alley, which were presumably made by Sir Charles Baskerville. It looked as if he had walked on tiptoe for at least a part of the way. Watson asked why Sir Charles had walked on tiptoe. Holmes instantly replied: “He was running, Watson—running desperately, running for his life, running until he burst his heart and fell dead upon his face.”

On another occasion, Holmes described the gait of a man: “... he was running hard with occasional little springs, such as a weary man gives who is little accustomed to set any tax upon his legs” (The Adventure of the Beryl Coronet). On still another occasion, we find an interesting reference to muscle physiology—one which only recently has been scientifically demonstrated. In The Man with a Twisted Lip Holmes makes this pregnant remark: “He is a cripple in the sense that he walks with a limp; but in other respects he appears to be a powerful and well-nurtured man. Surely your medical experience will tell you, Watson, that weakness in one limb is often compensated for by exceptional strength in the other.”

Muscle physiology is a highly specialized field. Considerable information is known about the chemical changes which take place during muscular contractions, but much more needs to be learned. One of the factors of supreme interest is the short period of time required for these complicated chemical and heat reactions. The problem is of more than academic interest, for it must be remembered that, in spite of all the modern machines at man’s disposal, the greater part of the work in this world is still done by muscular activity.

Any light thrown on the exact mechanism of muscle contraction may eventually prove to be of extreme practical benefit. It is indeed difficult to overemphasize this point. Finally, there are certain serious disorders of muscular functioning which may not only incapacitate individuals but actually cause their death. The distressing condition of patients suffering from muscular dystrophy is a poignant example. For this reason, if no other, a complete understanding of muscular contraction is of paramount importance.

Since the time when Dr. Watson studied physiology—eighty years ago—there have been vast developments in this field of science. There is hardly an area of scientific endeavor in which more research has been done or is in progress.