Let me just say up front: medical history is my jam. Now, I have many jams. Disco music, for example. Historical true crime. Hydrangeas. BBC Sherlock. Sherlock Holmes himself is far above jam–he’s pretty much the Nutella of Literary Detectives, but after doing preliminary research for an exhibit on the history of medicine in Indiana, playing the role of an 1836 doctor’s hired girl, and then, ages later, actually marrying a physician, I have to say that medical history is one of my favorite varieties. Raspberry, basically. So when I saw that the Baker Street Irregulars’ press was coming out with a book on Just That, I was very, very excited.
Sherlock Holmes may have invented his own job, but John H. Watson most assuredly did not. Instead, he trained extensively in order to enter a demanding profession which, in the Western world of the 19th century, was being thoroughly transformed by scientific and technological advancement. For example: in August 1852, the month and year that Watson was born (at least according to Baring-Gould), the London Journal of Medicine included, in its “Critical Digest of the Journals,” an excerpt from the American Journal of the Medical Sciences in which Dr. M. B. Haskins advocated blood-letting for the treatment of the beginning stages of inflammation. By the time 1896 rolled around, Dr. Watson could read about Glasgow surgeon John McIntyre’s X-ray of a halfpenny in a boy’s esophagus.*
It’s rare that we ever get to see Watson at work, however. He does some wound cleaning, he reads his medical journals, he visits patients, but when he’s “in harness,” he often seems to see medicine as his boring day job–the one which pays the bills, and supports him in his true calling as writer/detective. Dr. Katz, a pathologist, and Mr. Solberg, who has spent his career in healthcare planning and administration, have edited several previous BSI publications together, and are through both vocation and avocation, uniquely qualified to bring together members of the Sherlockian medical community in order to share their expertise.
Of course, one cannot talk about John Watson’s medical career without mentioning that of his creator. Daniel Stashower, therefore, takes the opening with a brief overview of Arthur Conan Doyle’s medical education at the University of Edinburgh, including a look at his inspirations: Henry Littlejohn (forensic evidence), Robert Christison (toxicology),William Rutherford (a physiology professor who bore a striking resemblance to the famous explorer George E. Challenger) and–of course–Dr. Joseph Bell, whom his former clerk would one day name as his primary model for Sherlock Holmes himself. Stashower, who also wrote a biography of Doyle, A Teller of Tales, is a gorgeous writer; even those readers already familiar with Dr. Doyle’s early career will find this chapter enjoyable.
After this brief glimpse into biography, we spend the remainder of our time in the Canon, beginning with a history of Bart’s Hospital, written by two graduates of its medical college: Drs. Jeffrey and Peter Kaplan (internal medicine and neurology, respectively). Besides its prominent role in Sherlockian history (so much so that there is actually a plaque commemorating this in the hospital’s museum), St. Bart’s is perhaps the only hospital in existence than can be said to have been founded by an actual saint. According to tradition, St. Bartholomew himself appeared to one Rahere, a member of the court of Henry II, and told him, that as his prayers for healing had been answered, he should build a priory and hospital in Smithfield–to “‘work like a man, and not to be anxious about means.'”**
Of course, John Watson was quite anxious about means when he first encountered Sherlock Holmes in the lab on that fateful day. Interestingly, however, the hospital is never mentioned again in the Canon. Although the Kaplans go on to give us a detailed picture of what Bart’s was like during Watson and Stamford’s time, our boys never seem to spend any more time there. If Holmes goes to pursue more experiments in the lab on those mornings when he gets up before Watson, we never hear about them; nor do we hear any more about his ground-breaking blood test. Did he ever write it up for a journal? A monograph? Did he ever have cause to use it? We don’t know! But as you’ll come to find, the best parts of Nerve and Knowledge are the questions it inspires.
Catherine Cooke, who manages both computers and the Sherlock Holmes Collection for the Westminster library system, follows with “Making Bricks Without Clay: The Medical Training of Dr. Watson,” taking us beyond Bart’s to discuss what John Hamish Watson actually studied, and where. Having had to do a little of this myself during the writing of A Curious Collection of Dates (and having found it very confusing) I was impressed with Ms. Cooke’s ability to deduce not only Dr. Watson’s student timeline and course of study, but also his possible motivations for becoming an Army surgeon at a time when the military was not necessarily seen as a viable medical career path. My notes for this chapter run on for pages, and I am sure I’ll find myself returning to it again and again.
Several other writers decided to look at Watson as a doctor. Pasquale and Jennifer Accardo, both physicians specializing in pediatrics, provide the reader with a glimpse of what Watson’s practice would look like–that is, if he ever happened to be in. I think that, thanks to various non-Sherlockian television series, we often get a picture of John H. Watson, MD, as a “simple country physician,” running out at all hours with his medical bag, delivering babies, treating a child’s measles, setting broken limbs and curing serious illnesses with his special tinctures. The Accardos point out that Watson was, in fact, a physician in London, and as such could maintain a practice for adults; note that we never really see him with children, and he certainly did not need to do obstetrics in a city filled with midwives.*** They also suggest that, as a general practitioner in a time in which his actual diagnostic tools and materia medica were limited–or even ineffective–Watson often found himself shepherding his patients through illness, rather than curing them of it, and likely spent just as much, if not more, time with their emotional stresses as their physical complaints. Such physical issues as he did see might well have come from the filthy, overcrowded city itself.
Dr. Watson may have begun his career a few decades too early to fully participate in the diagnostic and pharmaceutical revolutions of the 20th century, but he and his colleagues were at the forefront of new developments in germ theory and, by extension, public health. London was, for most his lifetime, an actual cesspool, and the “greasy yellow fogs” he describes in the canon were filled with toxic fumes–so much so that the soft coal that helped create them would eventually be outlawed after the “Black Fog” of 1952 killed 4,000 people. In his article, “Dr. John H. Watson: Chronicler of Detection, Observer of Infection, Dr. C. Paul Martin discusses the epidemiology common to an urban, industrial society whose members were constantly traveling the Empire. Sherlock Holmes wasn’t the only resident of 221B who could deduce a person’s occupation through observation, nor was Watson’s bout of enteric fever an anomaly. After this chapter, you’ll find yourself reading those 64 adventures through medical goggles.
In “A Scandal in Bohemia,” Holmes remarks that his friend is obviously “back in harness,” but I think it is safe to assume that he never really leaves it. Stories which involve illness or medicine attract him (MISS, RESI, RETI, VEIL, SPEC, etc.), and he often finds himself treating clients (ENGR, PRIO), or being asked for advice (SIGN). Have you ever wondered if brandy was an effective medication? Christopher Zordan has the answer for you, along with an in-depth look at Canonical pharmacology. What about brain fever? Is it a real thing? Is that what your headaches are? Step away from WebMD: Drs. Solito and Guerra (neuropsychiatrists both) give this topic a most comprehensive and enlightening treatment. In “I Should Value Your Opinion About the Mitral,” cardiologist Franklin Saksena explores heart disease in a century bookended by the invention of the monaural stethoscope (1813!) and the EEG (1903!)–and suggests that Jefferson Hope may have found a particular sort of consolation after the death of his beloved Lucy Ferrier. Dr. Bruce Parker, who has enviable canonical connections, shares an annotated manuscript which turns an X-ray on “Nonlethal Trauma in the Canon,” with a delicious promise of more to come. As much as I enjoyed all of these sections, however, I have to say that my very favorite was historian E.J. Wagner’s “The Excessively Expressive Corpse and the Canon.” Ms. Wagner, author of The Science of Sherlock Holmes,” uses forensic medicine, Civil War photographs, and what we know of false memories to explain why Holmes and Watson encounter so many emotive murder victims. It’s an enviable piece of deduction.
It’s common for many modern readers to assume that Dr. Watson was Holmes’ PCP–Granada helps to perpetuate this with scenes of the doctor treating his flatmate for various injuries, but we know from the Canon that Holmes consulted Dr. Moore Agar for symptoms of exhaustion, and had a house call from the eminent Sir Lesley Oakshott after being beaten by Baron Gruner’s thugs in ILLU.We know from DYIN that Holmes respected the doctor’s abilities, but I think it fair to assume that Watson was perceptive enough to realize that it would be impossible to be both Holmes’ close friend, and his physician. Dr. Richard Sveum (pediatrics) and Dr. Donald Pollock (psychiatry) have no such caveats, however, and were quite eager to diagnose our boys–Holmes in particular. Both men take their place on the exam table, while Holmes has a turn on the analyst’s couch and for once, you can take a peek at the charts without committing a HIPAA violation.
Three other writers chose to examine our heroes’ efficacy in their professions. I had the privilege of hearing one, Dr. Marina Stajic, speak on toxicology and the Canon at the Norwegian Explorer’s 2013 conference. Stajic, who is the Director of Forensic Toxicology for the Office of the Chief Medical Examiner, City of New York, and holds several professorships, puts Watson’s claim that Holmes is “well up in…poisons generally” to the test with a possibly surprising conclusion. Dr. Howard Brody, professor of family medicine and medical ethics, does the same for Watson’s adherence to the Hippocratic Oath, while attorneys Clifford Goldfarb, LLM and Hartley Nathan, LLM, QC, examine the issue of medical malpractice during the doctor’s active practice years. Could Watson ever have been sued by one of his patients? What would the outcome have been? I have to say, I disagree with their conclusion–take a look at the case and see what you think!
Finally, we have two comprehensive articles. Dr, Marilyn McKay, a dermatologist, contributes “Dressers to Professors: A Spectrum of Canonical Doctors,” in which she provides a look at each and every physician in the Canon, listed according to their particular rung on the medical ladder. Until this article, I had no idea just how many physicians appear in the Holmes stories–as heroes, victims, bit players and villains. Lloyd Rose, writer and one-time drama critic for The Washington Post, takes a step back from the consulting room to examine the most well-known actors to have played Watson on the big and small screens. According to Rose, each Watson since the Rathbone-Bruce films has been an attempt to rescue Holmes’ Boswell from Nigel Bruce’s infamous portrayal. Who falls short? Who succeeds? Aside from the fact that I don’t see Jeremy Brett’s Holmes as “brittle,” and I still like Nigel Bruce’s very lovable Watson, I agree with her conclusions. There is plenty of room for debate, however, and you may definitely disagree.
Anyone who has ever written an academic paper (or needs a subject for one) knows that the end of collection such as this typically includes a paragraph/ chapter on suggestions for further research. In graduate school, I may have used this section to, well, cover parts of my anatomy, but in Nerve and Knowledge, journalist Jenn Eaker uses “Final Diagnoses” to show the reader that there is plenty more to add to the subspecialty that is Medical Holmes. Where was Watson really wounded, for example? Did Sherlock Holmes need glasses? And isn’t Mycroft Holmes overdue for his own check-up?
As you read Nerve and Knowledge– as I definitely encourage you to do, you will find yourself coming up with your own questions. I am not at all sure of the decision in Hatherly v. Watson, for example, and found myself intrigued by the subject of 19th century medical malpractice in general. I also wondered–why did Watson decide to become a physician? What disillusioned him enough that he found writing and detecting preferable (most physicians don’t move in and out of practice; they’re either in, or they’re out.)? Did he ever testify at an inquest? Did he ever have a patient whose death was suspect? And of course, I had to wonder how Mary handled being a physician’s wife–a very different kind of life, which isn’t as documented as I thought it might be–except in literature, where doc wives tend to lead lives of boredom which end in tragedy.**** You’ll have inspirations of your own, no doubt, and if you do, please, do us all a favor and follow them up! Whether you do so through fiction or non-fiction doesn’t matter. But one of the greatest things any book can do is to inspire more writing! Here are your discharge papers–get to it!
Star Rating: 5 out of 5–“This is a wonderful book that gets it right.”
Canon Rating: 5 out of 5–“Watson, is that you?”
*The coin had been in there about 6 months and caused discomfort. Although McIntyre could see it, he couldn’t quite get it, but fortunately was able to push it down far enough that it eventually came out the regular way. He wrote up the case for the Journal of Laryngology, (1896), volume 10, page 231. It must be admitted that the Scottish surgeon was a pioneer when it came to using X-rays in medicine. It took a few decades for the new discovery’s medical applications to truly catch on. Information from: E. Posner, “The Early Years of Chest Radiology in Britain,” Thorax (1971) 26:233-239, accessed online at thorax.bmj.com.
**It’s difficult to know now which came first, the hospital or the priory. The quote is from the chapter, “Why Bart’s?” p. 15.
***This had its benefits and drawbacks. On the one hand, he never got called out at 2 am to deliver a baby, and he avoided some of the trauma that came with 19th century childbirth. On the other hand, it did cut off a revenue stream, and as we know from Conan Doyle’s own experiences, a physician’s life was not as lucrative as one might imagine.
****Flaubert’s Madame Bovary, for instance. Or Mary Elizabeth Braddon’s The Doctor’s Wife.