Chapter I: Part 1

A
DOCTOR
ENJOYS
SHERLOCK
HOLMES

“Nor must you find fault with me if I often give you what I have borrowed from my various reading, in the very words of the authors themselves” (Macrobius--trans. by Boswell).

Boswell: _The Hypochondriack_, No. XXI

A
DOCTOR
ENJOYS
SHERLOCK
HOLMES

Edward J. Van Liere

VANTAGE PRESS NEW YORK WASHINGTON HOLLYWOOD

FIRST EDITION

_All rights reserved, including the right of
reproduction in whole or in part in any form._

Copyright, 1959, by Edward J. Van Liere, M.D.

Published by Vantage Press, Inc.
120 West 31st Street, New York 1, N. Y.

Manufactured in the United States of America

Library of Congress Catalog Card Number: 59-14293

To my grandsons:
Edward Van Liere Batchelder and Terry Lewis Batchelder.

ACKNOWLEDGMENTS

I am indebted to several people for helpful criticism in the writing of these essays. My medical colleagues, Dr. Gordon R. McKinney, and Dr. David W. Northup, read a number of the essays and made many helpful suggestions. Professor Armand E. Singer of the Romance Language Department of West Virginia University critically reviewed all the manuscripts, and his scholarly erudition is indeed appreciated. The sympathetic assistance of my wife is also gratefully acknowledged. On occasion, she took me gently by the hand, and led me away from many a pitfall. The kind people who aided me must not be taken to task for errors of commission. I alone am responsible for these.

It is a pleasure to thank my capable and efficient secretaries, Mrs. Mildred Fisher and Mrs. Ann Beavers, for typing the manuscripts.

Several of these essays have appeared in the following journals:

_The West Virginia Medical Journal_
_Harvard Medical Alumni Journal_
_The Physiologist_
_The Baker Street Journal_
_The Quarterly of the Phi Beta Pi Medical Fraternity_
_The Student Journal of the American Medical Association_

Permission has been kindly granted to reproduce these essays here.

CONTENTS

Doctor Watson and the Weather 11 The Anatomical Sherlock Holmes 19 “Brain Fever” and Sherlock Holmes 25 Curare and Sherlock Holmes 31 Sherlock Holmes and the Portuguese Man-of-War 35 Doctor Watson and Nervous Maladies 41 Dogs and Sherlock Holmes 48 The Botanical Doctor Watson 54 The Surgical Doctor Watson 62 Sherlock Holmes, the Chemist 69 Doctor Watson’s Universal Specific 77 Doctor Watson, Endocrinologist 83 Genetics and Sherlock Holmes 88 The Zoological Doctor Watson 96 Doctor Watson, Cardiologist 102 The Physiologic Doctor Watson 108 Sherlock Holmes and Doctor Watson, Perennial Athletes 117 The Therapeutic Doctor Watson 127 Doctor Watson, General Practitioner 135

To undertake the writing of a large book is like entering on a long and difficult journey, in the course of which much fatigue and uneasiness must be undergone, while at the same time one is uncertain of reaching the end of it: whereas writing a short essay is like taking a pleasant airing that enlivens and invigorates by the exercise which it yields, while the design is gratified in its completion.

Boswell: _The Hypochondriack_, No. I

DOCTOR WATSON AND THE WEATHER

“It had been a close and rainy day in October.”

_The Resident Patient_

To me one of the most delightful touches in the tales of Sherlock Holmes is the frequent mention of the state of the weather. As far as I know, no one has emphasized the numerous references to the weather by Dr. Watson. Especially in the opening of the short stories can these be found, but they are not confined there, for they appear throughout the longer tales as well. Many instances can be cited to illustrate Dr. Watson’s allusions to the state of the weather. Let us freshen our memory by reviewing some of these.

Numerous references to the rains and winds of autumn may be found, such as, “... the weather had taken a sudden turn to rain, with autumnal winds” (_The Adventure of the Noble Bachelor_). And, in a similar vein, “Outside the wind still screamed and the rain splashed and pattered against the windows. This strange, wild story seemed to have come to us from amid the mad elements--blown in upon us like a sheet of seaweed in a gale” (_The Five Orange Pips_). And in _The Problem of Thor Bridge_, we find that, as Dr. Watson was dressing one morning, he observed how the leaves were being whisked away from the plane tree (we would call it a sycamore) which graced their back yard.

The events related in _The Hound of the Baskervilles_ took place in the autumn of the year, and several interesting allusions to this season may be found: “I walked over to the black window, and I looked through a blurred pane at the driving clouds and at the tossing outline of the wind-swept trees. It was a wild night....” Another reference, “A dull and foggy day with a drizzle of rain. The house is banked in with rolling clouds....” Also, “All day today the rain poured down, rustling on the ivy and dripping from the eaves....” And in another instance, “Rain squalls drifted across ... and the heavy, slate-coloured clouds hung low over the landscape, trailing in gray wreaths down the sides of the fantastic hills.” And lastly, an especially interesting allusion may be cited:

We hurried through the dark shrubbery, amid the dull moaning of the autumn wind and the rustle of the falling leaves. The night air was heavy with the smell of damp and decay. Now and again the moon peeped out for an instant, but clouds were driving over the face of the sky, and just as we came out on the moor a thin rain began to fall.

The paragraph just quoted pictures a rather wet autumn night, but not an especially bad one. In _The Adventure of the Golden Pince-Nez_, an extremely wild and stormy night toward the end of November is depicted. Dr. Watson describes vividly how the wind howled down Baker Street, and how the rain beat vigorously against the windows. Another reference may be cited which depicts gloomy autumn days: “It had been a close and rainy day in October....” (_The Resident Patient_).

It would appear, then, that many of Sherlock Holmes’ adventures took place during the fall of the year. It must be inferred that the dark and stormy days of autumn depressed the great detective, for we find him saying to Dr. Watson, “Draw your chair up and hand me my violin, for the only problem we still have to solve is how to while away these bleak autumnal evenings” (_The Adventure of the Noble Bachelor_).

From the instances just enumerated, it would seem that Dr. Watson was fond of picturing a background of wind, rain, and storm for many of his stories. He also described the well-known fogs of London with telling effect. In _The Adventure of the Copper Beeches_, Dr. Watson writes, “A thick fog rolled down the lines of dun-coloured houses, and the opposing windows loomed like dark, shapeless blurs through the heavy yellow wreaths.” And again, “It was a September evening and not yet 7 o’clock, but the day had been a dreary one, and a dense drizzly fog lay low upon the great city” (_The Sign of the Four_). In the same story, we find Holmes saying, “See how the yellow fog swirls down the street and drifts across the dun-coloured houses.” _In The Adventure of the Bruce-Partington Plans_, Dr. Watson tells how, during the month of November of 1895, such a heavy fog descended on London that it was impossible to see the houses on the opposite side of Baker Street.

In addition to wind, rain, storm, and fog, Dr. Watson makes reference as well to sharp winter weather. In _The Adventure of the Blue Carbuncle_, it will be remembered that Dr. Watson visited Sherlock Holmes two days following Christmas to give his friend the season’s greetings. Watson writes, “I seated myself in his arm chair and warmed my hands before his crackling fire, for a sharp frost had set in, and the windows were thick with ice crystals.” When he and Holmes set out to obtain information about the goose which had swallowed the blue carbuncle, Watson tells us: “It was a bitter night, so we drew on our ulsters and wrapped cravats about our throats. Outside, the stars were shining coldly in a cloudless sky, and breath of the passers-by blew out into smoke like so many pistol shots. Our footfalls rang out crisply and loudly....”

In _The Adventure of the Abbey Grange_, Watson describes an adventure which took place on a bitterly cold morning during the winter of ’97. On another occasion, Watson tells how he and Holmes went for a walk on a cold and frosty winter evening (_The Adventure of Charles Augustus Milverton_). A description of a beautiful winter day may be found in _The Adventure of the Beryl Coronet_: “It was a bright, crisp February morning, and the snow of the day before still lay deep upon the ground, shimmering brightly in the wintry sun.”

Mention is made too of the weather in the spring. On several occasions, references are made to the cold and stormy weather of the early part of this season: “It was a cold morning of the early spring, and we sat after breakfast on either side of a cheery fire in the old room at Baker Street” (_The Adventure of the Copper Beeches_). _The Adventure of the Speckled Band_ took place in the spring of ’83. Watson writes: “It was a wild night. The wind was howling outside, and the rain was beating and splashing against the window.” In _The Adventure of the Wisteria Lodge_, the good doctor writes that it was a cold, dark, windy March evening, and a fine rain was falling. And in _His Last Bow_, Watson writes that he had recorded in his notebook that, in the latter part of March in the year 1892, it was a bleak and windy day.

Milder spring weather also claimed Dr. Watson’s attention: “It was an ideal spring day, a light blue sky, flecked with little fleecy clouds drifting across from west to east. The sun was shining very brightly, and yet there was an exhilarating nip in the air, which set an edge to a man’s energy” (_The Adventure of the Copper Beeches_). In a similar vein, “It was a perfect day, with a bright sun and a few fleecy clouds in the heavens” (_The Adventure of the Speckled Band_). In _The Adventure of the Three Garridebs_, a lovely spring evening is mentioned, and Watson writes that the slanting rays of the setting sun made even a little prosaic street look golden.

For some reason or other, less frequent mention is made of summer weather. There are, however, several interesting references to this enjoyable season. In the story of _The Greek Interpreter_, Dr. Watson writes, “It was after tea on a summer evening....” And similarly, in _The Adventure of the Mazarin Stone_, our attention is called to the fact that it was the evening of a lovely summer’s day. It would be expected that somewhere in the stories an allusion would be made to the torrid days of August: “It was a blazing hot day in August. Baker Street was like an oven, and the glare of the sunlight upon the yellow brickwork of the house across the street was painful to the eye” (_The Adventure of the Cardboard Box_). An especially poignant reference to a hot summer night may be found in the story _His Last Bow_. Dr. Watson gives a vivid description of a hot night on the second of August. He mentions that there was an awesome hush and a feeling of expectancy in the sultry and stagnant air. The August to which reference is made was that of 1914--the beginning of World War I. In that holocaust, Great Britain lost the flower of her youth. She has not yet recovered from that mortal blow.

People living in the Victorian era, just like many of us today, were interested in barometric pressure. In _The Boscombe Valley Mystery_, an interesting reference to barometric readings may be found. Sherlock Holmes remarks to Lestrade of Scotland Yard: “How is the glass? Twenty-nine, I see. No wind, and not a cloud in the sky.” Somewhat later in the day, he mentions to Dr. Watson: “The glass still keeps very high.... It is of importance that it should not rain before we are able to go over the ground.” Fortunately, in this instance good weather prevailed, for Watson writes, “There was no rain, as Holmes had foretold, and the morning broke bright and cloudless.”

One might well ask why Dr. Watson emphasizes the state of the weather so often? Several reasons come to mind: To make the setting of his stories more realistic; to take up space in the manuscript; to use the subject of the weather as an excuse for some fine writing; to reveal Watson’s little-suspected love of nature; or perhaps still other reasons. Let us examine some of these.

It is well known that writers often have dirty weather prevailing when foul deeds are to be committed. Dr. Watson, however, does not abuse this privilege in his writings, although he does occasionally take advantage of unusual atmospheric conditions to make the story more exciting. A good example of this is to be found in the novel _The Hound of the Baskervilles_.

One recalls that Sherlock Holmes laid a trap to catch the villain, Stapleton. A part of the plan made it necessary for the hero, Sir Henry, to walk across the dismal moor alone after dark. Holmes had calculated that Stapleton would let loose his spectral hound that particular night. It was carefully arranged, of course, so that Sherlock Holmes, Dr. Watson, and Lestrade would kill the hound before any harm befell Sir Henry, and then catch Stapleton redhanded. All went according to plan until a dense fog started to rise from the adjacent Grimpen Mire. The low visibility produced by the unexpected fog almost upset Holmes’ well-laid plans and nearly caused the death of Sir Henry, because his friends could not see the hound until it was dangerously close to him.

Can the good doctor be accused of writing about the weather simply to make the manuscripts longer? I think not. In the first place, there is no evidence (certainly not in his early career) that the money he received for his stories bore any relation to their length. Further, and more important, a man with Watson’s imagination did not have to rely upon such a mundane topic as the weather to lengthen his stories. We can dismiss this argument promptly by stating that he was not guilty of padding his manuscripts in this manner.

Did he use the weather as an occasional excuse for fine writing? Probably not, although some of the paragraphs in which he describes the state of the weather, if examples of fine writing, are certainly examples of vivid writing as well. Several instances could be given, but one will suffice:

It was in the latter days of September, and the equinoctial gales had set in with exceptional violence. All day the wind had screamed and the rain had beaten against the windows, so that even here in the heart of great, handmade London we were forced to raise our minds for the instant from the routine of life, and to recognize the presence of those great elemental forces which shriek at mankind through the bars of civilization, like untamed beasts in a cage. As evening drew in, the storm grew higher and louder, and the wind cried and sobbed like a child in the chimney.

_The Five Orange Pips_

What other reasons could be given for Watson’s frequent allusions to the weather? There are, of course, the dapper gentleman and the Scotchman, who are conscious of the state of the weather since they deplore--for different reasons, to be sure--losing the press in their trousers by being caught in the rain. To the Londoner, however, who seems obliviously unaware of the somewhat disheveled state of his attire, such an explanation could scarcely apply. On the other hand, one cogent reason does come to mind. It must always be remembered that Watson was both a physician _and_ an author. Now the state of the weather is of perpetual interest to a general practitioner of medicine, and this is what Dr. Watson pretended to be. It is true that the physician who practices in the city probably is not as weather-minded as his colleague in the country. Dr. Watson lived in the great city of London, but often made his professional calls on foot and doubtless trudged through storm and rain: “When your round is a short one you walk, and when it is a long one you use a hansom” (_The Crooked Man_). He mentions that after his marriage he dropped in at 221B Baker Street from time to time when walking in that vicinity.

In point of fact, the kind of weather is of no little importance to a person who is called out at any time of day or night, as almost any physician will testify. This may be one of the important reasons why Watson makes such frequent mention of the weather in his stories.

All may not agree with me that such descriptions of the state of the weather add greatly to the interest of Watson’s writings. This is a matter of opinion; for doubtless there are many men who have little interest in the weather under any circumstances. Earl Derr Biggers, the creator of Charlie Chan, had one of his less liked characters remark that he was not interested in the weather, since he was not a cabbage. Be that as it may, I have always pitied those individuals who pay absolutely no attention to the weather; they are missing a great deal in life.

There are people who see beauty and interest only in a beautiful day. The poet probably was right when he sang, “What is so rare as a day in June?” But would anyone deny that there is beauty in a snowstorm or a sleetstorm, and is not a cloudburst or a thunderstorm an awesome spectacle, and can not even a duststorm be a striking phenomenon? Now nature, I grant, can overdo this matter of storms, and too much dust in the atmosphere or a week of rainy, sullen weather leave much to be desired.

To those of us who have been thrilled by the saga of Sherlock Holmes and Dr. Watson, and who have found enjoyment and relaxation in reading about these famous characters, I would like to make one further suggestion: Let us think of Dr. Watson not only as a practitioner of medicine, or only just as an amateur detective and confidant of Sherlock Holmes, but also as a man interested in many things--a lover of nature and one who could see charm in all her moods.

THE ANATOMICAL SHERLOCK HOLMES

“I believe he is well up in anatomy....”

_A Study in Scarlet_

A number of references to the anatomy laboratory and to portions of the cadaver may be found in the tales. Shortly after Watson’s return from India, he met his old friend Stamford at the Criterion bar in London. This was a memorable occasion, for it was Stamford who introduced Watson to Sherlock Holmes. When Stamford was telling Watson something about Holmes, he said, “I believe he is well up in anatomy....” Stamford made it clear, however, that Holmes was not a medical student, but did have pronounced scientific interests. He emphasized the fact that Holmes had a cold scientific approach to problems which deeply interested him and that he had been seen “beating the subjects in the dissecting room with a stick....” When Watson evinced some surprise at this unbecoming behavior, Stamford explained, “to verify how bruises may be produced after death” (_A Study in Scarlet_).

At first glance, Holmes’ activity seems to be inexcusable and betokens a deplorable disrespect for the dead. His researches must not be regarded in this light, however, for it may be of distinct medicolegal interest to ascertain whether the bruises on a body were produced before or after death. This problem has been studied extensively, and information concerning it may be found in books dealing with medicolegal matters. Holmes’ early interest and study in this field are quite understandable, for at that time he was laying the foundation for his brilliant career as a specialist in the study of crime.

When Watson first started rooming with Holmes he found that the latter “Sometimes ... spent his day ... in the dissecting rooms....” (_A Study in Scarlet_). In one instance, reference is made to the preservation of bodies in the anatomy laboratory: “Bodies in the dissecting rooms are injected with preservative fluids.” The agents employed in the embalming fluid are given: “carbolic, or rectified spirits would be the preservative....” (_The Adventure of the Cardboard Box_).

Osteology must have appealed to Holmes, since bones are frequently mentioned. Once when Holmes was trying to analyze a difficult case, he made allusion to Cuvier, the famous anatomist and anthropologist: “Cuvier could correctly describe a whole animal by the contemplation of a single bone....” (_The Five Orange Pips_). In _A Study in Scarlet_, a description of the alkali plains of our great West is given; these pointed but gruesome sentences may be found:

Here and there are scattered white objects which glisten in the sun and stand out against the dull deposit of alkali. Approach and examine them. They are bones: some large and coarse, others smaller and more delicate. The former have belonged to oxen and the latter to men.

In another instance, Holmes was consulted about a “charred fragment of bone” which had been recovered from a heating furnace in a private dwelling. He showed it to Watson, who without hesitation stated that it was the upper condyle of a human femur (_The Adventure of Shoscombe Old Place_).

One early spring afternoon, Holmes and Watson upon returning from a walk found that a visitor had left his pipe on the table. Holmes picked it up and examined it carefully. Watson writes, “He held it up and tapped on it with his long, thin forefinger, as a professor might who was lecturing on a bone” (_The Yellow Face_). This is an apt allusion, for many medical students will remember the occasion when an instructor in anatomy held a bone in his hand, pointed out areas where muscles had been attached, and commented on other characteristic features. One is reminded of the story of the poet-physician Oliver Wendell Holmes, who was professor of anatomy at Harvard for many years. Once when lecturing on the sphenoid bone (a bone of the skull having an exceedingly complicated architecture), he is reputed to have said something like this: “Gentlemen, I have in my hand the sphenoid bone. Gentlemen, I say d---- the sphenoid bone!” Any medical student who has studied this bone will wholeheartedly agree with the remark.

Mention is made also of fossil bones. When Holmes and Watson visited the house of Nathan Garrideb, they noticed a large cupboard full of them. Holmes was invited to take a seat, but his host found it necessary to clear the chair of bones. Obviously, Garrideb was a most enthusiastic collector (_The Adventure of the Three Garridebs_).

Sherlock Holmes presumably enjoyed anthropology, for several references to this science may be found in the tales. In _The Hound of the Baskervilles_, when Dr. Mortimer first met Sherlock Holmes, the doctor rather facetiously said to him:

“I hardly expected so dolichocephalic a skull or such well-marked supra-orbital development. Would you have any objection to my running my finger along your parietal fissure? A cast of your skull, sir, until the original is available, would be an ornament to any anthropological museum. It is not my intention to be fulsome, but I confess that I covet your skull.”

Holmes apparently was slightly annoyed at this frank but somewhat insensate disquisition, and remarked, “You are an enthusiast in your line of thought, I perceive, sir, as I am in mine.”

On another occasion when Dr. Mortimer was speaking of Sir Henry Baskerville, he stated: “A glance at our friend here reveals the rounded head of the Celt, which carries inside it the Celtic enthusiasm and power of attachment. Poor Charles’ head was of a very rare type, half-Gaelic, half-Ivernian in its characteristics.”

Dr. Mortimer obviously was a keen observer, a person of scholarly tastes and “a most learned man in his own line.” When he was telling Sherlock Holmes and Dr. Watson of his friendship with Sir Charles Baskerville, he remarked, “... and many a charming evening we have spent together discussing the comparative anatomy of the Bushman and the Hottentot.”

Interest in anthropology is evinced further by mention of prehistoric man. One day, while Dr. Watson was walking on the moor, he met the naturalist Stapleton, the villain in _The Hound of the Baskervilles_. Watson’s attention was attracted to the circular rings of stone on a hillside. He asked his companion whether they were the ruins of ancient sheep pens. Stapleton replied, “Prehistoric man lived thickly on the moor....” When Watson questioned him as to when the moor was inhabited; the answer was, “Neolithic man--no date.”

Another allusion to ancient man may be cited. In the house of Garrideb, as mentioned, Holmes and Watson noticed above a cupboard a series of plaster skulls; the names “Neanderthal,” “Heidelberg,” and “Cromagnon” were printed underneath them (_The Adventure of the Three Garridebs_). Not only the anthropologist but the trained biologist as well is, of course, quite familiar with the names of our early ancestors.

Once Holmes’ knowledge of anthropology helped him solve an important case. A maiden lady had received in the mail a small cardboard box containing two human ears--one that of a woman. Holmes was called in, and during the course of his investigations visited the receiver of the gruesome package. He noted the resemblance of one of the severed ears to those of the lady upon whom he was calling. Because of the striking likeness, he felt certain that the person whose ear had been dismembered was a close relative of the lady he had come to interview.

Somewhat later, he gave a lecture--a thing he was prone to do--to Dr. Watson on the surface anatomy of the ear:

... there is no part of the body which varies so much as the human ear. Each ear is as a rule quite distinctive and differs from all others.... I ... examined the ears in the box with the eyes of an expert and had carefully noted their anatomical peculiarities.... I perceived that her [Miss Cushing’s] ear corresponded exactly with the female ear I had just inspected. The matter was entirely beyond coincidence. There was the same shortening of the pinna, the same broad curve of the upper lobe, the same convolution of the inner cartilage. In all essentials it was the same ear.

Of course, I at once saw the enormous importance of the observation. It was evident that the victim was a blood relative, and probably a very close one.

_The Adventure of the Cardboard Box_

This was an exceedingly astute observation on Holmes’ part. He was right when he remarked that as a rule each ear is quite distinctive, and cleverly pointed out the important anatomical features. In any event, the study he made of Miss Cushing’s ear aided him greatly in solving the mystery of the cardboard box, and we know that the murderer was promptly apprehended.

In the story just related, a newspaper of the day was supposed to have suggested that the preserved ears had been sent by medical students as a joke. It appears that the maiden lady at one time had had unpleasant dealings with medical students: “... she let her apartments in her house to three young medical students, whom she was obliged to get rid of on account of their noisy and irregular habits.... [The ears were sent] by those students who owed her a grudge and who hoped to frighten her by sending her those relics of the dissecting rooms.”

Although this theory was later proved to be false, it was not too farfetched. Indeed, many, many stories can be told about the behavior of medical students in the anatomy laboratory. A favorite minor prank, for example, is to cut off a finger or an ear and slip it into the pocket of an unsuspecting visitor. This bit of horseplay probably discourages future visits to the anatomical laboratory. Although anatomy instructors deplore such practices, they are likely to overlook them, because laymen are not encouraged to visit dissecting rooms.

In the opening of one of the stories, we find Holmes stooping over a low-power microscope (_The Adventure of Shoscombe Old Place_). He explained to Watson that there were epithelial cells in the microscopic field. As far as I am aware, this is the only reference to individual body cells to be found in the tales. It appears, then, that Holmes was much more interested in gross structures of the body, especially osteology, than in microscopic structures.

We have seen that many pertinent allusions to anatomical science may be found in the tales. In one instance, at least, Holmes’ intimate knowledge of surface anatomy--that is, the configuration of the external ear--enabled him to solve handily a perplexing mystery. The allusions made to anatomical matters are of especial delight to those of us in the field of biology.

“BRAIN FEVER” AND SHERLOCK HOLMES

“I have only just recovered from nine weeks of brain fever and am
still exceedingly weak.”

_The Naval Treaty_

Several years ago, there appeared in the _Journal of the American Medical Association_ a provocative article with the arresting title, “Brain Fever,” written by Louis Cassamajor.[1] The author is to be commended for his courage in choosing this unusual title, and the _Journal_ to be congratulated for publishing it. Although I welcome the term “brain fever,” I did rub my eyes, because I had not seen it employed for a long time. In my youth the term was used commonly, but was dismissed from my mind when I commenced the study of medicine. It was relegated to the same limbo as the old expression “typhoid malaria.”

In order that I may develop my thesis, a brief review of Cassamajor’s article is in order. The author points out that, in the early part of the past century, considerable literature appeared describing a disease known as “brain fever” (called also “hydrocephalic fever” and sometimes “encephalitis”). For the main part, it occurred in children. The illness subsided after a few days to a couple of weeks, and the patient usually recovered.

The author brings out further that, although the disease was apparently accompanied by fever, there are no recorded temperatures, for the modern clinical thermometer was not invented until 1868. It is emphasized, also, that no neurological signs appeared in the case reports. It was only after the writings of Erb and of Westphal in 1875 that neurological examination, as we now know it, began to develop. For some unknown reason, about 1850 mention of the disease disappeared from medical literature. The author, however, makes the statement: “Undoubtedly the condition does exist today.”

Following a brief historical introduction, the author gives in some detail the case histories of four children, the youngest six and one-half and the oldest eleven years of age, whom he had rather recently diagnosed as suffering from “brain fever.” It is highly gratifying that they all made a complete recovery. The disease is characterized by signs and symptoms indicating a considerable brain involvement, “including convulsions, comas, paralyses, cerebellar asynergy and a sort of bulbar palsy.” The onset is irregular, except when head trauma has been previously sustained, when it may be sudden.

One reason, among others, why this stimulating article especially interested me was that the term “brain fever” called to my mind the immortal stories of Sherlock Holmes. In them several individuals are described as suffering from this condition. It is of nostalgic interest to examine the circumstances which surrounded these victims when they were stricken.

We find in one of the stories that a housemaid, with an unstable Celtic temperament, “had a sharp touch of brain fever.” She had had a violent love affair with a handsome but perfidious butler, who had thrown her over for another girl. Following her partial recovery, she had taken a terrible vengeance and was directly responsible for her faithless lover’s death. When questioned about him by the master of the household, she became hysterical and unmanageable: “For two days [she] had been so ill, sometimes delirious, sometimes hysterical...” (_The Musgrave Ritual_). She evidently made a rapid recovery, for on the third night she disappeared and her whereabouts were never discovered.

In another story, a young girl whose mother had died was treated cruelly by her father, who had remarried. She had an income of her own which she generously allowed her father to use. When she fell in love with a young man, her father tried desperately to make her sign a contract providing that, in the event of marriage, he could still use her money. This she refused to do. He placed her in solitary confinement so that she could not see her lover, and treated her inhumanly in other ways: “... he kept on worrying her until she got brain fever, and for several weeks was at death’s door” (_The Adventure of the Copper Beeches_). It is pleasant to relate that she recovered and succeeded in eloping with her lover and presumably lived happily ever after.

In still another story, in which Sherlock Holmes attempted to gain an audience with a middle-aged spinster, he was informed that she was too ill to be interviewed. Her doctor said: “She has been suffering since yesterday from brain symptoms of great severity. As her medical adviser, I cannot possibly take the responsibility of allowing anyone to see her. I should recommend you to call again in ten days” (_The Adventure of the Cardboard Box_). This illness, somewhat later in the story, is referred to specifically as “brain fever.”

The illness had developed when this spinster heard that conscientious diplomat. Through his own carelessness, how-her younger sister had been foully murdered by her husband. It was the spinster who, by wicked machinations, had been largely responsible for her sister’s death. It is noteworthy that Holmes was advised to come back ten days later. This indicates that the disease was not of long duration.

One of Dr. Watson’s former schoolfellows, Percy Phelps, wrote him, “I have only just recovered from nine weeks of brain fever and am still exceedingly weak.” In his letter, he further informed Dr. Watson that he wished to consult with Sherlock Holmes, and asked his friend to bring him, since he was in deep trouble. This able young man was an earnest and ever, he had lost an important state document. In narrating his story to Sherlock Holmes and Dr. Watson, the patient gave a vivid description of his distressing illness: “Here I have lain, Mr. Holmes, for over nine weeks, unconscious, and raving with brain fever ... in my mad fits I was capable of anything. Slowly my reason has cleared, but it is only during the last three days that my memory has quite returned” (_The Naval Treaty_).

This poor fellow had an illness of long duration and, according to the story, his strength came back but slowly. It will be recalled that Sherlock Holmes solved the mystery and was able to place the important state document again in the patient’s hands. As far as we know, he eventually made a complete recovery in spite of the severity of the attack.

In _The Hound of the Baskervilles_, it will be remembered that the heir, Sir Henry Baskerville, narrowly escaped death on the moor. The shock of the adventure with the hound, coupled with the fact that the woman with whom the heir was in love was actually the wife of the villainous Stapleton, his would-be murderer, was too much for our hero. Watson writes: “But the shock of the night’s adventure had shattered his nerves, and before morning he lay delirious in a high fever under the care of Dr. Mortimer. The two of them were destined to travel together round the world before Sir Henry had become once more the hale, hearty man that he had been before he became master of that ill-omened estate.”

In this last instance, Watson does not specifically state that the patient was afflicted with “brain fever,” but the implication is plainly there. It is, moreover, worthy of note that it took the victim a long time to regain his health.

The individuals whom Dr. Watson described as suffering from “brain fever” obviously had all passed through a terrific mental storm--in modern parlance, they had sustained “severe psychic traumata.” Whether this alone could cause “brain fever” is a moot question. The condition presumably is caused by a virus. That a severe brain storm could cause the lurking virus to become active seems unlikely.

Previously it has been mentioned that a head injury apparently is capable of hastening the onset of brain fever in children. (We will waive the fact that the cases Dr. Watson described are adults.) A physical injury presumably produces certain organic changes in the brain or in its meninges, which perhaps could precipitate an attack of encephalitis, assuming that the virus was present. There is no particular evidence that the patients mentioned in the tales had suffered a head injury.

It is true, of course, that great emotional upsets are often accompanied by marked vascular disturbances. These may manifest themselves in the brain as well as in other parts of the body. It is not conceivable that encephalitis would follow an emotional storm. Be that as it may, this can be said: It is generally agreed that anything which lowers the resistance of an individual may make him more susceptible to disease. In the cases described by Dr. Watson, the virus may have been present, and the shock produced by the emotional storm, which all these people experienced, might have precipitated an attack of encephalitis (brain fever).

If this seems too farfetched, and the reader cannot go along with me, I can say only that I am sorry. I will have to use the argument that one should allow a talented and imaginative writer like Dr. Watson a liberal degree of poetic license.

Dr. Watson may have used the term “brain fever” loosely, and perhaps as synonymous with extreme nervous exhaustion. He does, however, mention that some of the sufferers became delirious. This symptom is suggestive of encephalitis. Also, in one or two instances the victim recovered rather quickly, which points to an acute condition such as encephalitis rather than nervous exhaustion. I am cognizant that some may regard this as a specious argument.

The question could be raised whether the patients described by Dr. Watson suffered from hysteria. This condition cannot entirely be ruled out. Hysteria has protean manifestations, and may even be accompanied by fever. The great mental storms through which these patients passed are conducive to hysterical attacks. The fact, however, that these individuals ran a high fever and were dangerously ill would militate against a diagnosis of hysteria. It seems fairly safe to assume that the disease from which they suffered probably had an organic basis.

The reader should be reminded that Dr. Watson began the study of medicine only a short time after the researches of Erb and of Westphal on the nervous system had been published. Neurology had not yet come into its own, and it is likely that the medical profession did not make fine distinctions when dealing with diseases of the brain or its meninges. It probably is not charitable for me to suggest that the professors who taught the young Watson about nervous diseases in the year 1876 or thereabouts had not kept up with the literature in their field--a fault of which we are all more or less guilty.

Dr. Watson has been taken to task by some critics in the medical profession for using the term “brain fever,” and the implication has been made that his employment of a meaningless term was unworthy of a medically trained man. Now it appears that this criticism is unjustified. We might quarrel with Dr. Watson as to what brought on the attacks of “brain fever,” or whether the victims actually had the disease in the cases he so vividly described, but the term itself is acceptable.

The Holmesian enthusiast will rejoice that the term “brain fever” is again in good repute and is accepted by the medical fraternity. The very fact that the staid _Journal of the American Medical Association_ has published an article bearing the title “Brain Fever” has stripped criticism of all weapons. The loyal Holmesian no longer needs to feel apologetic for the nomenclature Dr. Watson used to describe a rather unusual and fortunately rare clinical entity.

CURARE AND SHERLOCK HOLMES

“... for the action of the alkaloid is rapid.”

_A Study in Scarlet_

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.

SHERLOCK HOLMES AND THE PORTUGUESE MAN-OF-WAR

“I did what I could to relieve his pain.”

_The Adventure of the Copper Beeches_

_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.