A doctor enjoys Sherlock Holmes

Curare is used as a lethal agent in two of the Sherlock Holmes stories. In the novel A Study in Scarlet, liberties are taken with the pharmacologic properties of curare, for actions are ascribed to this agent which it could not possibly have had. But in The Adventure of the Sussex Vampire, curare is employed scientifically and with telling effect; and indeed, an interesting plot is built around this agent.

Let us first examine the role curare played in A Study in Scarlet. Holmes, it will be remembered, wished to determine the toxicity of certain pills and instructed Dr. Watson to fetch a little dog, which already was in extremis: “... that poor little devil of a terrier which has been bad so long, and which the landlady wanted you to put out of its pain yesterday.” Watson commented on the state of the animal: “Its laboured breathing and glazing eye showed that it was not far from its end. Indeed, its snow-white muzzle proclaimed that it had already exceeded the usual term of its existence.” Then, according to Dr. Watson, some of the pills which were thought to contain curare were dissolved in milk and offered to the sick dog: “The unfortunate creature’s tongue seemed hardly to have been moistened in it before it gave a convulsive shiver in every limb and lay as rigid and lifeless as if it had been struck by lightning.”

Before we comment on the sudden death of the terrier, let us see what befell Enoch Drebber, who was forced by Jefferson Hope to swallow a pill containing curare. The wretched Drebber met the same fate as the aged terrier, for we find Watson writing: “... the action of the alkaloid is rapid. A spasm of pain contorted his features; he threw his hands out in front of him, staggered, and then with a hoarse cry, fell heavily upon the floor. I turned him over with my foot, and placed my hand upon his heart. There was no movement. He was dead.”

The deaths of Drebber and the terrier were dramatically portrayed, and Dr. Watson is to be congratulated on the vivid picture he presented. The trained scientist however, could not entirely accept the events as he outlined them. The difficulty lies in the fact that curare is relatively harmless if taken by mouth. If extremely large doses are administered on an empty stomach, sufficient curare may be absorbed to cause grave symptoms, but death would not be instantaneous, for absorption is slow from mucous surfaces. If, on the other hand, there were an open lesion in the stomach or the upper part of the small intestine, such as an ulcer, then rapid absorption could take place, and death would ensue in a relatively short time, although not as rapidly as portrayed in the story. The action of curare is rapidly lethal only if injected directly into the blood stream. It would stretch our credulity too far to assume that both the dog and the man had either a gastric or a duodenal ulcer.

Let us now consider how curare was employed in the story The Adventure of the Sussex Vampire. It will be recalled that Sherlock Holmes was asked by Mr. Robert Ferguson to investigate certain irregularities in his household. Ferguson, a fine gentleman, was very much in love with his beautiful Peruvian wife; but one day, to his infinite horror, he had actually seen her sucking blood from a wound on the neck of their year-old baby. She refused to make any explanation, and the husband and wife became estranged. There was another child in the family, an invalid boy of fifteen, Ferguson’s son by a previous marriage.

Dr. Watson accompanied Sherlock Holmes to Ferguson’s country home on a dreary autumn day. One of the rooms of the old house contained a fine collection of South American utensils and weapons which presumably had been brought from Peru by the mistress of the house. As Holmes was examining this interesting collection, the movements of a dog attracted his attention. Holmes noted that the dog experienced difficulty in walking. The astute detective asked Ferguson what ailed the dog. His host replied that the thing had also puzzled the veterinarian. The latter had thought it might be spinal meningitis. Holmes asked a few more questions about the dog, and finally remarked that the picture the dog presented was very suggestive.

The frantic husband insisted that Holmes tell all he knew or suspected. Holmes then gently explained to the indulgent father that his fifteen-year-old invalid boy was so insanely jealous of his healthy baby half-brother that he had tried to do away with him by wounding him with an arrow treated with curare. The boy had first tried out the poison on the dog. Ferguson’s wife, in an heroic effort to save her baby, had sucked the site of the arrow wound. The mystery was solved, and Holmes and Watson had the keen satisfaction of clearing up the grave misunderstanding between Ferguson and his lovely Peruvian wife.

In this story, curare was handled in an expert manner. It is known, of course, that the South American Indians dipped their arrowheads into a curare solution before using them to kill birds. The curare was rapidly absorbed from the wound made by the arrow; the wing muscles became paralyzed; and the bird plummeted to earth—an airplane without wings.

The Adventure of the Sussex Vampire was written many years ago. What is the status of curare today? This interesting compound has actually insinuated itself from the jungle not only into the experimental laboratory but into the surgical amphitheater as well. This is not the place to take up in detail the clinical use of curare, but a few remarks are in order.

Relaxation of the muscles is often highly desirable in surgical procedures; it is not surprising, therefore, that the anesthetists have added curare to their armamentarium. Although curare has no anesthetic action per se, it has been found to serve as a useful adjuvant to certain anesthetic agents. It has been used also for the convulsions of strychnine poisoning, tetanus, and hydrophobia, as well as certain spastic contractures. It could furthermore be of help in the management of dislocations, especially in heavily muscled individuals.

Curare should be employed only by experienced workers, for the muscles of respiration may become paralyzed, and unless mechanical respiration is given immediately, the patient will die of asphyxia. Fortunately, curare is quickly excreted by the body, and the patient will soon start voluntary breathing movements.

In conclusion, let us turn to the tales. The Adventure of the Sussex Vampire could have been written only by an individual quite familiar with the action of curare, and with a good understanding of clinical medicine. This story is of especial interest to physicians. Not only is curare used in the plot in an interesting and unusual manner, but certain psychosomatic problems are presented: The estrangement of the husband and wife; and a clear portrayal of how the mind of a physically handicapped youngster may become warped, even though reared in an excellent environment.