A doctor enjoys Sherlock Holmes

John H. Watson, M.D., practiced medicine in the city of London in the early eighties of this past century. This was a long time ago—nearly seventy-five years. At the time of which we write, Roentgen had not as yet discovered the X-ray, and Ehrlich’s “606” (salvarsan) was not available for the treatment of syphilis. Banting and Best, the Canadian physiologists, had not given insulin to the world, nor had Minot and Murphy of Harvard discovered that liver extract was an efficient agent in the treatment of pernicious anemia, a heretofore fatal blood disease. The sulfonamide drugs and the antibiotics, such as penicillin and streptomycin, presumably were only a dream.

From what has been related, it appears that Dr. Watson’s therapeutic armamentarium, insofar as efficacious drugs are concerned, was sadly limited. But the fact must not be forgotten that he had at his command a number of powerful medicines: morphine, cocaine, belladonna, and strychnine, to name a few.

Let us turn to the stories and see what medicines Dr. Watson used in his practice and under what conditions they were employed.

It appears that iodoform and silver nitrate were well known drugs, for Holmes on one occasion remarked to him: “... if a gentleman walks into my rooms smelling of iodoform, with a black mark of nitrate of silver upon his right forefinger.... I would be dull indeed if I do not pronounce him to be an active member of the medical profession” (A Scandal in Bohemia).

Iodoform was introduced as an antiseptic about the year 1879. For many years it was widely employed as a dusting powder, especially to diminish infection of open wounds and to promote granulation. Its persistent and penetrating odor, as well as its relative ineffectiveness, gradually brought it into disfavor. This is probably just as well, for its use is not entirely without danger, especially when iodoform is applied over an extensive area where a good deal of it can be absorbed.

Silver nitrate still enjoys a wide usage. It is employed to produce astringent, antiseptic, and caustic effects. Even many laymen know that silver nitrate will remove “proud flesh.” Unfortunately, it has the property of staining the skin “with a black mark” (as Holmes remarked), which incidentally is often difficult to remove. It may persist until it is virtually worn off, although recent and superficial stains can be removed by painting the area with a ten per cent solution of potassium iodide.

As might be expected, Dr. Watson found it necessary on several occasions to resort to morphine to alleviate pain. We find, for example, that when Kitty Winter, the cast-off mistress of the infamous Baron Gruner, threw vitriol in the Baron’s face, Dr. Watson administered a hypodermic of morphine to the wretched Baron to ease the intense suffering (The Adventure of the Illustrious Client). On another occasion, when Professor Presbury was savagely attacked by his wolfhound, Watson immediately gave morphine to the unfortunate professor (The Adventure of the Creeping Man). In still another instance, when Carlos, the mastiff, had attacked Rucastle, Watson probably would have used morphine had he had it in his possession. He wrote: “I did what I could to relieve the pain” (The Adventure of the Copper Beeches). He did not state, however, what agent he employed.

On one occasion, at least, it was necessary to administer morphine to Sherlock Holmes. He had been attacked and beaten severely by two ruffians. Sir Leslie Oakshott, the eminent London surgeon, had been called in on the case. He later tersely remarked to Watson that Holmes suffered from lacerated scalp wounds, and there were also some bruises. It had been necessary to take several stitches. Morphine had been administered (The Adventure of the Illustrious Client). Morphine, because it is a dangerous habit-forming drug, should be used only when absolutely indicated. It is noteworthy that Dr. Watson administered morphine only when the patient had suffered a grave physical injury. He is to be commended for his conservative attitude.

On many occasions, when assisting Sherlock Holmes with his cases, Dr. Watson found it necessary to administer a stimulant to those individuals who had suffered a physical injury or had been under great emotional stress. His favorite remedy for such conditions was brandy. Numerous instances may be cited when this agent was employed as an emergency measure. Dr. Watson obviously believed firmly in the efficacy of brandy as a stimulant, and, indeed, claimed to have saved the life of an individual by its use:

Dr. Watson in this beautiful passage expresses the wish of every physician.

Brandy and whiskey were not the only stimulants used by Dr. Watson; in point of fact, he employed several others. We have noted previously that ammonia was administered along with brandy to Mr. Melas, the Greek interpreter. Physicians will recall that ammonia is the principal ingredient in so-called smelling salts. The vapors of ammonia when inhaled stimulate the medullary centers, causing an increase in respiration, and by action on the vasomotor center produce a rise in blood pressure.

In his heroic efforts to save the life of a woman who had been chloroformed nearly to death, Dr. Watson gave ether intravenously with successful results (The Disappearance of Lady Frances Carfax). At any rate, he records that the patient regained consciousness. Ether is not often given in this manner as a stimulant, and the question could be raised whether it was indicated under the condition which faced Dr. Watson. I am afraid that this was an instance in which the patient lived in spite of the treatment.

A popular and effective stimulant, namely, caffeine, was used to bring a young woman out of a stuporous state produced by opium. Dr. Watson relates that a couple of cups of very strong coffee brought her out of this state (The Adventure of Wisteria Lodge). Dr. Watson used the classical agent. Strong coffee is still used today in morphine poisoning, although relatively new preparations, such as metrazol, nikethamide, and amphetamine are at present the drugs of choice. Coffee is, of course, easy to obtain, is a relatively harmless stimulant, and has the pleasing virtue of not producing disagreeable aftereffects.

On one occasion, the nature of the stimulant administered was not disclosed. We find the following: “... while his nurse poured him out a glass of some stimulating medicine” (The Naval Treaty). We can only guess at the contents of the glass, but more than likely it contained either brandy or whiskey. We have previously pointed out that these agents were frequently prescribed as stimulants.

Dr. Watson, strangely enough, administered amyl nitrite to a patient who presumably was suffering from catalepsy. He writes, “I had obtained good results in such cases by the inhalation of nitrite of amyl....” (The Resident Patient). It will be recalled that this rather rare condition is characterized by a rigidity of all the skeletal muscles; the patient, as a consequence, tends to remain in any position in which he is placed. The reason Dr. Watson used amyl nitrite in this instance is not clear. The nitrites are frequently prescribed to reduce systemic blood pressure or to relieve angina pectoris. Surely there is no evidence in the literature that the nitrites are of aid in cataleptic states. We can dismiss the matter by assuming that in this instance Dr. Watson used amyl nitrite empirically.

Oil is mentioned as a therapeutic agent in at least two of the stories. Both Dr. Watson and Sherlock Holmes had occasion for its use. When Baron Gruner had vitriol thrown in his face, Dr. Watson tried to alleviate the poor wretch’s pain by bathing his face in oil and applying cotton to the raw areas (The Adventure of the Illustrious Client).

On another occasion, Holmes relates how he treated Murdoch, who had come into contact with the giant jellyfish. He used cotton-wool which had been soaked in salad oil; and he related that this application greatly relieved the pain (The Adventure of the Lion’s Mane). This adventure took place in the country, and we may assume that there was little, if any, medication on hand. The patient was suffering intensely, and Holmes did what he could to assuage the pain with the material he had at his disposal. He showed real ingenuity by making use of a homely preparation. Morphine obviously was badly needed, and it is a pity that Dr. Watson was not there to administer it. But it must be remembered that, at the time this happened, Holmes had retired to the Sussex Downs and Dr. Watson was in London. A perusal of the story shows, however, that the patient had been given liberal quantities of brandy, so perhaps he got along fairly well without morphine after all.

Dr. Watson used carbolized bandages to dress the hand of the unfortunate hydraulic engineer who had, a few hours previously, lost his thumb in an adventure which nearly cost him his life. “I sponged the wound, cleansed it, dressed it, and finally covered it over with cotton wadding and carbolized bandages” (The Adventure of the Engineer’s Thumb). Carbolized bandages are no longer used in present-day surgery. Historically, it is of interest to record that carbolic acid became widely known as an antiseptic through its introduction by Lister in 1867.

Dr. Watson does not often mention hypnotics. We find in one of his stories that it was the custom of an invalid, Mr. Percy Phelps, to take some sleeping potion: “... you did not take your usual draught that night” (The Naval Treaty). We shall never know what the “usual draught” contained. The barbiturates which are so widely used today were unknown when Dr. Watson practiced medicine. Bromides were employed not only for sedation but for inducing sleep as well. The draught of which Watson spoke might have contained chloral hydrate, for it once enjoyed wide usage as a hypnotic. It is a potent and dangerous drug and, as generally known, is used by gangsters (among others) in what are inelegantly but expressively referred to as “knockout drops.”

An interesting reference is found to an alterative in one of the stories (The Disappearance of Lady Frances Carfax). Holmes, meeting Watson in an establishment which specialized in Turkish baths, asked his friend why he insisted upon this type of therapy. The latter replied that a Turkish bath is actually an alterative in medicine. He explained further that an alterative was a cleanser of the system. An “alterative” is defined in Webster’s Unabridged Dictionary as: “A medicine or treatment which gradually induces a change, and restores healthy functions without sensible evacuations.” A modern medical dictionary states: “An obsolete term originally used for drugs said to reestablish healthy functions of the system.” (Dorland’s Illustrated Medical Dictionary. Philadelphia: W. B. Saunders Company, 1947).

Present-day medical students probably never heard of alteratives. Many middle-aged physicians, however, will remember them well, for formerly alteratives were used extensively in therapeutics, and included the following preparations: iodine, arsenic, iron, and the compounds of mercury. Nowadays, a more scientific attitude is taken toward these agents, and they are prescribed only if there is a specific need for them: for example, iron for certain anemias, mercury for syphilis, and so on. If one considers the esteem in which alteratives were held in the latter part of this past century—and, for that matter, in the early part of the present one—it is surprising that Dr. Watson did not mention alteratives more frequently.

One wishes that Dr. Watson had mentioned other drugs used in his practice. In the early part of the twentieth century, a survey in England showed that physicians considered that from thirty to thirty-five drugs were necessary to practice medicine satisfactorily. In the stories of Sherlock Holmes, the names of about a dozen occur. Dr. Watson probably mentioned only those which for the main part are familiar to the layman.

Drugs are, of course, an important part of the armamentarium of doctors, especially those engaged in general practice. From the evidence at hand, obviously Dr. Watson was not a therapeutic nihilist, but neither can he be accused of prescribing drugs loosely or in excessive doses.

The matter of overdosing with drugs calls for a brief comment. The famous poet-physician, Oliver Wendell Holmes, wrote: “If the whole materia medica (excepting opium and ether) as now used, could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes.” These were harsh words; but when written, timely. The indiscriminate use of drugs was directly responsible for the genesis of the ill-conceived homeopathic system of medicine founded by Hahnemann. The followers of this school used drugs in such minute doses that they were virtually ineffectual. It is, indeed, an ill wind which blows no good, for the rise of homeopathy had a sobering influence on many physicians of the allopathic school who were using drugs lavishly, but not well. Let us not forget, however, that the prescribing of drugs plays only a part—albeit an important one—in the successful practice of medicine.

In conclusion, we may think of Dr. Watson briskly setting out to answer the call, carrying his trusty bag filled with the recognized and popular drugs of that period. He undoubtedly prescribed these fairly liberally, and firmly believed in their curative powers. Most of Dr. Watson’s patients probably got well with the aid of, or perhaps in spite of, his prescriptions. Those who were not helped by his medication were undoubtedly benefited by his kindliness and his sympathetic understanding of their ailments.