The Adventure of the Lion’s Mane has always appealed to me, although I am mindful that this story is not universally popular with Holmesian enthusiasts. The story was written by Sherlock Holmes himself. The title alone arrests one’s attention. Immediately, one thinks of a magnificently maned lion at bay, or, as one artist pictures him, standing in the moonlight on the shore of the ocean, roaring defiantly at the incoming waves.

As the adventure unfolds, however, we learn that while the story does deal with the ocean, a lion is not mentioned, but rather a huge jellyfish, Cyanea capillata. It is also called the “Lion’s Mane,” for as Holmes wrote, the jellyfish resembled a mass of tangled hair which looked as if it might have been procured from a lion’s mane.

Let us recall that in this story the death of a person, as well as that of a dog, was produced by the poisonous sting of the Lion’s Mane. The victim of this catastrophe was Fitzroy McPherson, a young scientist who had suffered from rheumatic fever, and whose heart had been damaged. In spite of his cardiac ailment, he was portrayed as a fine athlete and an expert swimmer. It was his custom to take a daily dip in the ocean in and out of season.

At the time of which we write, Sherlock Holmes was living in retirement on the Sussex Downs, not far from the place where McPherson often swam. One fine morning in July, following a severe storm, Holmes and his neighbor Stackhurst, who kept a preparatory school, were taking a bracing walk. To their intense surprise and dismay, they discovered the figure of McPherson, a science master of Stackhurst’s establishment, coming up the path staggering as if drunk. As they came nearer, he uttered a terrible cry and fell upon his face. They rushed to his side and turned him on his back. He was in extremis. Just before he expired, he indistinctly uttered words that sounded like “lion’s mane.” The cause of his death was a mystery even to Holmes.

A few days later, Ian Murdoch, a colleague and close friend of the late McPherson, went swimming in the exact spot where the latter had met his untimely death. Holmes dramatically describes how Ian Murdoch lurched in the room, extremely pale, and with his clothes all rumpled. It was an effort for him to stand; finally, he staggered to the sofa and collapsed from the excruciating pain. He experienced great difficulty in getting his breath, his face appeared livid, and beads of cold sweat stood on his brow. It appeared that he was also in extremis.

It is not necessary to relate here the steps which Holmes took in solving this baffling mystery. Suffice it to say that he came to the conclusion that both McPherson and Murdoch had come into contact with a huge jellyfish. He became absolutely convinced of this when he discovered in the attic of his home a book by J. G. Wood entitled, Out of Doors. Holmes found in this book a description of a patient who had been in contact with a jellyfish. The victim complained that while the local pain was severe, it was nothing compared to the pangs which surged through his chest. It was impossible for him to stand up. The cardiac beat became quite irregular; the heart would virtually stop, and then several violent pulsations would occur.

Admittedly, Holmes’ story is a thrilling one. The criticism to be made, however, is that although Cyanea capillata can produce a nasty sting, it probably could not produce death, especially in a healthy person. There is no question but that it would be an unpleasant experience for a swimmer to come into contact with Cyanea. In a standard textbook of biology, Cyanea arctica, another species of the same genus, is described as a creature which may measure six feet in diameter and bear tentacles reaching the astonishing length of one hundred and thirty feet! It can readily be seen that a swimmer could easily be stung by such a jellyfish before recognizing the danger.

Since it is generally believed that Cyanea capillata cannot cause the death of an individual, and since the symptoms described in The Adventure of the Lion’s Mane were so grave, the coelenterate which Holmes had in mind probably was no other than Physalia, commonly known as the Portuguese man-of-war. Exposure to the tentacles of this creature is apt to produce a chain of alarming symptoms.

Owing to my warm interest in Holmes’ story I read with profit and keen enjoyment a case history reported by Klein and Bradshaw.[2] A twenty-year-old man, while swimming about twenty feet off North Miami Beach, Florida, came into contact with a Portuguese man-of-war. His attention was drawn to a purple object floating near him, which he thought to be a balloon. He swam up and touched it. Immediately, he became aware of a sharp stinging sensation on his arm and shoulder. Noting several strands which he could not brush off, he left the water at once, and a companion removed them with a towel. Underneath each strand could be seen a “painful fiery red welt.” Soon he found it difficult to breathe, and shortly suffered from severe abdominal cramps. A little later, he showed signs of shock and mental confusion.

A swimmer exposed to the tentacles of these large jellyfish may, according to Klein and Bradshaw, suffer pain, swelling, and redness in the affected part. In a few minutes to an hour following exposure, systemic effects may appear, such as anxiety, muscular pains and cramps, dyspnea, constriction of the throat, cardiac symptoms, and prostration. The authors stress that the alarming symptoms which often follow stings from coelenterates suggest the action of a powerful neurotoxin.

Waite,[3] writing in the same year, stresses the fact that contact with a Portuguese man-of-war produces symptoms indicative of anaphylactic shock, such as pallor, sweating, faintness, fall in blood pressure, and the like. He mentions that although there have been no authenticated medical reports of death as a result of the sting of a Portuguese man-of-war, it could happen if complicated by anaphylactic shock.

One wonders, of course, what would have happened if the patient described by Klein and Bradshaw had been some distance from shore. If anaphylactic shock had occurred within a few minutes, the patient no doubt would have drowned if no one had been in the vicinity to help him. A swimmer who experiences difficulty in breathing, who is afflicted with severe abdominal cramps, who shows signs of shock, and who is mentally confused, will certainly drown. Indeed, any one of these four symptoms could provoke disaster in deep water.

The treatment instituted by Klein and Bradshaw is worthy of our attention. The patient was hospitalized and given calcium gluconate and benadryl intravenously. Epinephrine and atropine were administered intramuscularly, and ammonia applied locally. I might add that a purist could raise the question whether all this medication was necessary. The next day, the itching areas were treated with tetracaine. The patient made an uneventful recovery, although it took about three weeks before the lesions were healed. Waite emphasizes that, in case of anaphylactic shock, epinephrine or benadryl should be given immediately. He warns further that if angioneurotic edema appears, the air passageways should be cleared, oxygen supplied, and, if necessary, a tracheotomy performed. The latter constitutes heroic treatment, but may, of course, save a person’s life.

Let us return to The Adventure of the Lion’s Mane, in an attempt to ascertain what medical agents were used fifty years ago to treat the sting of coelenterates. As previously mentioned, Sherlock Holmes was in retirement and living alone, so unfortunately he could not call upon his friend Dr. Watson to prescribe for Ian Murdoch.

Holmes, however, rose to the occasion and made an earnest attempt to help the patient, for he writes that he soaked cotton in salad oil and applied it to the wounds. He felt that this greatly alleviated the pain. The famous detective showed real ingenuity in making use of such a homely remedy. He also gave the suffering man liberal quantities of brandy, which doubtless had a narcotizing effect. There is considerable evidence that brandy was widely used for medicinal purposes at the turn of the century, when this adventure is supposed to have occurred.

It is of interest to speculate upon what medication Dr. Watson would have administered to Ian Murdoch had he been in attendance. At that time, neither benadryl nor calcium gluconate nor, for that matter, tetracaine was available. On the other hand, epinephrine, atropine, and ammonia were even then widely used. Dr. Watson presumably would have given a hypodermic injection of morphine and offered the patient brandy, as did Sherlock Holmes. He, too, doubtless would have applied some soothing ointment to the painful lesions, or, like Klein and Bradshaw, might have used ammonia. It is even possible that he would have employed epinephrine. The latter certainly was indicated, for the symptoms described by Holmes were those of anaphylactic shock. This syndrome (anaphylactic shock) was not well understood fifty years ago. In point of fact, the word “anaphylaxis” was coined in 1907 by Richet. This, as mentioned earlier, was the year when the adventure was supposed to have taken place. Holmes, however, wrote The Adventure of the Lion’s Mane probably in 1925, since it was first published in 1926. At that time, the significance of anaphylactic shock in man was pretty well understood, and it is possible that he was familiar with this condition.

It is a pity that we have to resort to speculation, and that Dr. Watson was not in attendance instead of Holmes, a nonmedical man. If such had been the case, Watson probably would have mentioned the agents medical men used at that time. This would not only have satisfied our sympathetic curiosity but, what is more important, these facts would have been of historical interest. We then could actually have compared the medical agents which were prescribed fifty years ago with those currently employed for the grave symptoms of shock produced by the excruciatingly painful stings of coelenterates.