DISSECTING THE MEDICAL DOYLE C. Frederick Kittle, M.D. © C. Frederick Kittle, 1997 MEDICAL CASEBOOK OF DOCTOR ARTHUR CONAN DOYLE: From Practitioner to Sherlock Holmes and Beyond by Alvin E. Rodin and Jack D. Key [1] This book, describing the medical aspects of Sir Arthur Conan Doyle’s life, their expression in his writings, and his personal and professional humanism, is a detailed and comprehensive treatise. The authors were an admirable pair for this task: Dr. Alvin E. Rodin, a board-certified pathologist, was Professor and Chairman of Postgraduate and Continuing Medicine at Wright State University School of Medicine in Dayton, Ohio; Jack D. Key was Librarian and Associate Professor of Biomedical Communications at the Mayo Foundation in Rochester, Minnesota. Both had a long interest in medical history and Arthur Conan Doyle authenticated by numerous publications over many years. Much of what has been written biographically about Conan Doyle has relatively ignored the deeply ingrained aspects of his medical training and its effect throughout his writings and life. Rodin and Key not only tread on fresh ground, they plowed it deeply, and provide a unique look at Conan Doyle. And unlike most biographies, often written to tell a good story aided by liberal literary license, their account provides extensive, accurate and detailed documentation of the multitude of events they describe. The book contains three general sections, each with two chapters. Section One considers Arthur Conan Doyle as medical student and practitioner, and his medical writings. Section Two discusses his medical and nonmedical fiction. Section Three concerns itself with medical events related to Conan Doyle, Sherlock Holmes, and Dr. Watson. Then follows a reconsideration of Dr. Conan Doyle, forty pages of notes of additional information about many of the previous comments, and thirty-five pages of appendices listing the subject’s medical chronology, medical writings, Edinburgh’s faculty and Conan Doyle’s medical school grades, the non-Sherlockian doctors, and medical references in the Sherlock Holmes stories. There are sixty pages of documentation listing 947 entries, and 22 illustrations. One cannot exaggerate the detail and comprehensive manner in which Rodin and Key portray each subject; they describe not only Conan Doyle’s activities, but also present extensive background information, as for example the history of the towns in which Conan Doyle practiced, of the diseases discussed, and the doctors presented, etc. As a result there are few questions left unanswered about Conan Doyle’s medical life and its relation to his writings and activities. Only a little new information has been found since this book’s publication. Along the way Rodin and Key carefully and repeatedly document Conan Doyle’s thoughtfulness in his dealings with people and social causes. This viewpoint like the medical events depicts a new aspect of Conan Doyle, since other biographies have devoted themselves more to occurrences themselves rather than his closer, more personal actions. i For many years, Conan Doyle’s attendance and graduation from the University of Edinburgh with the degrees of B.M. (Bachelor of Medicine) and C.M. (Master of Surgery), and his attainment of an M.D. degree four years later, were acknowledged in but casual fashion. That he practiced medicine for eight years in Southsea was mentioned, along with his brief venture as an ophthalmologist in London. But these were spoken of disparagingly, e.g. ‘he left medicine because his practice was insufficient,” and mentioned only in relation to the chronology of his literary activities. His obituaries in 1930 essentially ignored the medical part of his life, only one giving a reasonable view of his medical activities and their influence on his literary efforts. His son Adrian’s The True Conan Doyle gives no attention to his father’s medical activities except to minimize the role of Dr. Bell as the prototype for Holmes. Even the medical profession in general disparaged Conan Doyle as a doctor. The British Medical Journal’s obituary of him stated: He was one of many writers who have started out to make a career in medicine, and under the impulse of a creative spirit abandoned practice for the life of letters. . . he practised obscurely at Southsea . . . They were lean years . . . In the dull interludes of shabby-genteel practice he polished up his talent for writing, and from time to time short stories from his pen would be accepted by editors of magazines. Wrong, as Rodin and Key demonstrate, but the common attitude. Conan Doyle has always been overshadowed by Sherlock Holmes, but Rodin and Key clarify how the rigorous and demanding years in medical school, the hours spent day and night with sick people observing their suffering, their joys and their deaths, were the source of many memories and impressions that found expression in Conan Doyle’s writings. Rodin and Key show how these experiences, combined with his plethora of interests, provided a full palette for his brush. Other authors have written about medicine — the diseases, doctors, treatments, disabilities, etc. — but none as effectively as Conan Doyle. More than any other writer, he deserves credit for introducing the medical genre into literature and to the reading public. Conan Doyle came from family distinguished as artists on the paternal side. His only medical relative was his maternal grandfather, William Foley, M.D., who died relatively young. Conan Doyle’s parents married early and produced a large family. His father became progressively more addicted to alcohol, and his mother the prop of the family. Conan Doyle’s decision to become a physician was prompted in part by Dr. Bryan Charles Waller, who boarded with them. Edinburgh was an outstanding school. Its faculty was renowned, and Conan Doyle’s years there were filled with talk of a philosophy of rational thinking —Darwin, Mendel, and others fueling a new scientific approach that was instilled in the young students’ minds. One of his teachers in surgery, Dr. Joseph Bell, stood out from the others by his dynamic style of teaching and a diagnostic acumen based on close observation. Conan Doyle applied and was accepted as a clerk to assist Bell in his out-patient clinics, a most profitable and far-reaching experience. To earn money, Conan Doyle spent seven months as surgeon on a whaling ship in the Arctic. He also worked as an assistant to three physicians in the Midlands, Drs. Richardson (Shropshire), Elliot (Shropshire), and Hoare (Ashton Manor), acquiring much background for subsequent stories.[2] Three short stories were published by Conan Doyle while still in medical school, plus a medical letter (“Gelseminum as a Poison”) in the British Medical Journal in 1879, reporting from observations on himself about the effects of increasing doses of a drug prescribed for neuralgia. He found time for an occasional poem such as “The Medical Love Song,” most likely written to a young lady whom he was seriously considering for marriage. (His anatomy and physiology go slightly awry in the latter since the mitral valve is on the right side and the heart contracts with systole rather than diastole.) The Medical Love Song My heart at each systole swelling Still murmurs its passion for you — The Venous side, dear, is thy dwelling, A temple untainted and true And there by the fossa ovalis Where the mitral your chamber shall screen, There ’mid reduced haemoglobin Oh that is your palace, my queen. [3] Edinburgh was later epitomized in The Firm of Girdlestone as: a great unsympathetic machine, taking in a stream of raw-boned cartilaginous youths at one end, and turning them out at the other as learned divines, astute lawyers, and skilful medical men. Of every thousand of the raw material about six hundred emerge at the other side. The remainder are broken in the process. . . . those whose manliness and good sense keep them straight have gone through a training which lasts them for life. . . They have learned self-reliance, confidence, and, in a word, have become men of the world while their confreres in England are still magnified school-boys. ii  In Victorian times, becoming a member of the medical profession did not automatically assure prestige and wealth. To obtain additional finances for a start in practice, but also because of Conan Doyle’s natural propensity for adventure, he took yet another sea job after receiving his B.M. & C.M. in 1881. This voyage along the west coast of Africa as ship’s surgeon provided further material for stories. Then began the search for a place to practice medicine. The first was in Plymouth with a recent graduate, Dr. George Budd, his senior at Edinburgh by one year. They separated abruptly in several months, and Conan Doyle went to nearby Southsea, a suburb of Portsmouth: experiences well-portrayed among the short stories of Round the Red Lamp (1894) and in The Stark Munro Letters (1895). During eight years at Southsea, his practice, slow at first, gradually increased. Writing produced welcome additional income; he also engaged in sports and other non-medical activities — the Portsmouth Literary and Scientific Society, the Masonic Lodge, and the Liberal-Unionists. Between graduation in 1881 and the start of his practice in Southsea, four short stories and two articles on photography appeared in print. But by the time he left Southsea, eight years later in December 1890, there were about thirty fiction stories, five novels, a medical thesis, and at least fifteen medical and nonmedical magazine articles and letters to newspapers. The topics were varied: leucocythemia, syphilis, contagious disease legislation, American medical education and its worthless diplomas, gout, compulsory vaccination for small pox, Koch’s alleged cure for tuberculosis, and a popular magazine article, “Life and Death in the Blood.” His M.D. was granted in 1885 one month before his marriage to Louise Hawkins. “After my marriage,” he remarked, “my brain seems to have quickened and both my imagination and my range of expression were greatly improved.” In 1887 Sherlock Holmes made his first appearance, and Conan Doyle’s life was soon to change. The Sign of the Four (1890) further enhanced the characters of Holmes and Watson. The White Company and Raffles Haw were completed before his departure from Southsea, although not published until 1891 and 1892 respectively. His curiosity about Koch’s claims about tuberculosis prompted him to visit Berlin for a firsthand look. On this trip a London dermatologist, Malcolm Morris, urged him to leave his small town and come to London. Rather abruptly Conan Doyle took this advice, to specialize in ophthalmology after several months’ training in Vienna. (While, he wrote to his sister Lottie, “keeping literature as my milk-cow.”) His stay in Vienna was brief — about two months, much of that spent writing Raffles Haw. Nevertheless he acquired considerable knowledge about the eye, later displayed in his writings. In London he rented an office near medically fashionable Harley Street, but by his account, no patients came; with no one in the waiting room, he had more than ample time for writing. One month after he began practice he had a severe bout of influenza, and in the quietness of reflection that accompanies a serious illness: It was then, as I surveyed my life, that I saw how foolish I was to waste my literary earnings in keeping up an oculist’s room in Wimpole Street, and I determined with a wild rush of joy to cut the painter and to trust for ever to my power of writing. I remember in my delight taking the handkerchief which lay upon the coverlet in my enfeebled hand, and tossing it up to the ceiling in my exultation. I should at last be my own master. Rodin and Key write: “Conan Doyle at last committed himself to his true vocation, but one which was to be inextricably influenced by previous experiences.” There was a further medical experience ten years later. Conan Doyle became emotionally involved with the Boer War. Turned down for military service because of age, he became a voluntary physician with Langman’s Hospital in Bloemfontein, South Africa, arriving in Capetown on March 21, 1900, to begin one of the major episodes of his life, politically and medically. His experiences there resulted in several accounts: The Great Boer War (1900), an article in the British Medical Journal about enteric fever (1900), and The War in South Africa (1902). Perhaps most important was his understanding of the etiology, epidemiology and prevention of enteric (typhoid) fever, resulting in a marked change in military policy in the crowded and irregular conditions of war. He vigorously supported preventive inoculation, something loudly and vigorously disputed by Bernard Shaw. Both were equally prominent authors, but Conan Doyle brought more scientific and medical understanding to the subject. After the Boer War, Conan Doyle continued his friendship with medical organizations, giving frequent toasts at various medical societies and a reception for the British Medical Association at his home in 1913. Politically he supported the Daylight Saving Bill of 1908 as likely to increase the general standard of health, particularly for children. Venereal disease from prostitution gained his attention, and he spoke out forcefully against opponents of the Contagious Disease Act. He spoke and wrote on behalf of the humanitarian treatment of the Congo’s natives, criticizing the “civilized nations” who had seen “a hapless race, whose safety they have guaranteed, robbed, debauched, mutilated and murdered, without raising a hand or in most cases even a voice to protect them.” And he continued to support vivisection, a raging quarrel in Victorian times as at present. Statements that there was not “an atom of evidence” that any lives had been helped by the torture of animals quickly drew a response to the contrary from Conan Doyle. But he was equally opposed to animal cruelty; his autobiography refers to Professor Rutherford at Edinburgh as “a rather ruthless vivisector, and though I have always recognized that a minimum of painless vivisection is necessary, and far more justifiable than the eating of meat as a food, I am glad that the law was made more stringent so as to restrain such men as he.” His ophthalmological knowledge benefitted George Edalji, convicted of maiming horses and cattle, with Conan Doyle’s cogent arguments about Edalji’s ophthalmologic problems, in letters to Lancet and the British Medical Journal, contributing to Edalji’s release from prison. In later life, Conan Doyle was to utilize his medical resources in his Spiritualistic activities, by measuring changes in pulse rate in various mediums. In his Spiritualism he remained unconvinced of spirit healing, accepting some cases, but not abandoning his deeply ingrained beliefs in biologic theory and medicine: “While in Boston I spent an hour or so in the magnificent temple of the Christian Scientists. I confess that I have little sympathy with these people. . . . Faith healing and healing by what we now call suggestion are as old as history.” iii In an opening address to St. Mary’s Medical School in London that he gave in 1910, Conan Doyle addressed a theme which Rodin and Key are at pains to emphasize in their coverage of the role medicine played in his life and literary work: humanism and idealism in medicine, as expressed in his public actions and fictional writings: the value of kindliness and humanity as well as of knowledge. . . . A strong and kindly personality is as valuable an asset as actual learning in a medical man. I have known men in the profession who were stuffed with accurate knowledge, and yet were so cold in their bearing, and so unsympathetic in their attitude, assuming the role rather of a judge than a friend, that they left their half-frozen patients all the worse for their contact. And he admonished the students: Unselfishness, fearlessness, humanity, self-effacement, professional honour — these are the proud qualities which medicine has ever demanded from her sons. They have lived up to them. It is for you youngsters to see that they shall not decline during the generation to come. Rodin and Key show repeatedly how Conan Doyle displayed medical “humanism,” even under the worst of conditions, quoting an observer of his medical work in during the Boer War: It was difficult to associate him with the author of Sherlock Holmes: he was a doctor pure and simple, an enthusiastic doctor too. I never saw a man throw himself into duty so thoroughly heart-and-soul. . . He threw open the door of one of the . . . wards, and what I saw baffles description. The only thing I can liken it to is a slaughter house. It fascinated me to watch their cheery doctor carrying the sunshine with him wherever he went, worshipped by all. Rodin and Key summarize his actions at this time: “Tales of horror crowd upon one; stories of men in delirium, wandering about the camp at night; stories of living men in the agonies of disease, with dead men lying on either side.” It was in such a hell that Conan Doyle managed to maintain his equilibrium and his human sensitivity. This was not true of some others. At one point he settled a serious dispute, close to mutiny, between Major Drury and many of the supporting staff. iv It was a medical recognition of Conan Doyle at the time to be invited to address the opening of St. Mary’s Medical School. His talk, “The Romance of Medicine,” reflected many of his experiences as a physician, his philosophy — the view that medicine “tinges the whole philosophy of life, and furnishes the whole basis of thought” — and the effect of disease on historical events. As he told his audience, “I am not an amateur, and . . . there are few phases of medical life, from the sixpenny dispensary to the two-guinea prescriptions, that I have not had personal experience.” Detailed dissection of a human being from scalp to toes provides not only a large and remarkable fund of knowledge — it also develops the basis for an uniquely intimate relationship with people and their lives. The physician is taught to be dispassionate in his treatment, but the overpowering dismay and feeling of helplessness when a patient’s disease relentlessly progresses to death exceed that of any other profession. Medicine follows rigid methods, and the physician must be methodical, compulsive, even obsessive, in his thoughts and actions. Whether the patient is rich or poor, pleasant or nasty, calm or angry, responsive or not, the responsibility, accountability, and worry impacts the physician throughout every hour of the day. There is little opportunity for creativity. Expressions of inner thoughts and feelings must be controlled and repressed. With Conan Doyle, the genes of creativity were well-established; they blossomed naturally in his writing, and proved more satisfying to him; but years of medicine emerged frequently in his writings. There is another aspect to which Rodin and Key give consideration. For people subjected to emotional trauma in their childhood or teen years, such trauma often remains unresolved. The distortion trauma causes can emerge from the subconscious or unconscious in numerous ways. It can stay submerged but break forth at intervals toward others or themselves. It can form an inappropriate type of behavior toward others, displaced into pathways equally inappropriate and often destructive for themselves (drugs, alcoholism, gambling, etc.), or it can be sublimated and dissipated by creative efforts (writing, art, etc.). Conan Doyle’s writings are compatible with the last such management of his childhood experiences — memories of his family’s crowded home and relative poverty in Edinburgh, and his father’s alcoholism perhaps accompanied on occasion by physical abuse. Rodin and Key list fifty-eight nonfiction and fiction titles by Conan Doyle between 1879 and 1928. There are 118 doctors mentioned in his short stories and novels, fifty-five in the medical short stories and novels, sixty-three in the nonmedical writings. For the most part his doctors are not main characters. They add lustre and interest to the plots, but usually receive only casual attention, doctors and diseases serving as cameos for the central themes: More usually physicians who become serious writers abandon the clinic wholly or visit it only intermittently. But they retain the clinician’s way of looking. Their writing carries that special imprint peculiar to those who have felt, smelled and dwelled among fevers, madness, blood and abscesses. The distinguishing feature of Doyle’s writings was that he knew how to tell a story in an interesting fashion. His imagery stimulates, his style is graphic and his descriptions are vivid. His medical scenes portray the basic sciences, clinical information, and doctors of his times. Rodin and Key arrange Conan Doyle’s medical literary topics and allusions into five areas: medical writings; medical fiction; nonmedical fiction; detectives, doctors and diseases; drugs and detection. The total number of medical expressions is quite numerous, more so than with any other author. Conan Doyle’s medical fiction ranged from the years 1884 to 1911 with the majority written before 1900. When he ceased medical practice and became interested in more fields, so did the number of his medical references in writing become less. Fifteen of his eighteen medical short stories were published in Round the Red Lamp by 1894, covering a wide range of topics — the life of a medical student, starting a medical practice, episodes of practice, the emotional problems of dealing with patients, a love story involving a female physician, several of cuckoldry and the husband’s retaliation, insanity and porphyria, the pain of childbearing, inheritable diseases, and vogues in therapy — electrotherapy and hypnotism. In them were moments of humor, some self-deprecatory, as related by Rodin and Key: The enormous interest in Sherlock Holmes and Dr. Watson and the zeal displayed in the magnitude of commentaries about these stories have obfuscated a realistic perception of Doyle and his medical references in the Canon. Certainly the genesis of this famous couple was based on the people Doyle encountered in his medical school days, particularly Dr. Joseph Bell and at least the two Dr. Watsons that he met, one Dr. Patrick Heron Watson, an Edinburgh graduate, and a Dr. James Watson, practicing at Southsea. The dermatologist Malcolm Morris reportedly drilled and tested Doyle on the value of minute observation and what could be deduced thereby. But credit has been given and accepted by Doyle’s surgical teacher at Edinburgh as Conan Doyle acknowledged: “I thought of my old teacher Joe Bell, of his eagle face, of his curious ways, of his eerie trick of spotting details. If he were a detective he would surely reduce this fascinating but unorganized business to something nearer to an exact science.” Detective fiction was just emerging in the Victorian era with the stories of Edgar Allan Poe, Emile Gaboriau, Fergus Hume, R. Austin Freeman and Wilkie Collins. But the greatest appeal and best characterization belonged to Sherlock Holmes who provided a new configuration, almost forcing the others off-stage. Conan Doyle’s plots were unusual and had the ability to hold readers’ interest. There are a great number of medical references in the Sherlock Holmes stories, with thirty-four physicians and two professors, of physiology and of comparative anatomy. Most are general practitioners. Almost all the physicians (save Watson) are peripheral, reinforcing the background, flitting in and out of the stories in various roles, and sharpening the readers’ attention. Rodin and Key illustrate how Conan Doyle adopted many of his own experiences in describing these physicians. Of equal interest although not as frequent are Conan Doyle’s accounts of forensic medicine: a test for blood, footprints, fingerprints, changes in the body after death, and deductions based on trauma in various parts of the body. Sir Henry Littlejohn, one of his professors at Edinburgh, was also the City of Edinburgh Police Surgeon, in the years when forensic pathology was becoming established as a medical specialty and science. v Conan Doyle left a lifetime of diverse activities that almost defy description — sports, champion for the unjustly accused, patriotic efforts, war historian, an advocate of the divorce rights of women, and a major player in Spiritualism. His medical comments described the knowledge of his time but often made surprising predictions about the future of medicine. Rodin and Key show how his excellent medical knowledge, an insatiable curiosity, a vivid imagination, and the artistry of expression combined with his sympathy for humanity to produce a remarkable and memorable author. Most of this outstanding book resulted from their minute and careful search in newspapers, journals, and books. There are a few personal letters from library collections. Dame Jean Conan Doyle, his only living child, aided by her encouragement and personal recollections. Rodin and Key later added to their initial presentation with their commentaries on Conan Doyle’s Tales of Medical Humanism and Values [4], containing Round the Red Lamp, six other medical short stories, and “The Romance of Medicine.” It is doubtful if any further significant information about medicine and Conan Doyle’s writings will be found when the family archives are finally released for scholarly use again. NOTES 1. Malabar, Florida: Krieger Publishing Co., 1984. 2. Paul Lester has provided additional information about these experiences in his book Sherlock Holmes in Birmingham, Studley, Warwickskire: Brewin Books, 1989. 3. From the Arthur Conan Doyle Archives at Bibliotheque Cantonale et Universitaire Lausanne-Dorigny. 4. Malabar, Florida: Krieger Publishing Co., 1992. Editor’s Note Fred Kittle is a notable bookman in addition to his long and distinguished career as a thoracic surgeon. Two years ago he was honored by a lengthy profile in the monthly periodical of The Caxton Club, Chicago’s century-old bibliophile society. A long-time collector and scholar of Doyleana — not only Dr. Conan Doyle, but the other artistically gifted members of that family — he also figured in 2002’s book Among the Gently Mad: Strategies and Perspectives for the Book-Hunter in the 21st Century by Nicholas A. Basbanes. His collection of Doyleana is now at Chicago’s Newberry Library, which in its honor hosts a Conan Doyle symposium on the Saturday morning following each year’s Hounds of the Baskerville (sic) annual dinner in Chicago. Dr. Kittle is “Jack Stapleton” in the BSI.

DISSECTING THE MEDICAL DOYLE

C. Frederick Kittle, M.D.

MEDICAL CASEBOOK OF DOCTOR ARTHUR CONAN DOYLE:

From Practitioner to Sherlock Holmes and Beyond

by Alvin E. Rodin and Jack D. Key [1]

This book, describing the medical aspects of Sir Arthur Conan Doyle’s life, their expression in his writings, and his personal and professional humanism, is a detailed and comprehensive treatise. The authors were an admirable pair for this task: Dr. Alvin E. Rodin, a board-certified pathologist, was Professor and Chairman of Postgraduate and Continuing Medicine at Wright State University School of Medicine in Dayton, Ohio; Jack D. Key was Librarian and Associate Professor of Biomedical Communications at the Mayo Foundation in Rochester, Minnesota. Both had a long interest in medical history and Arthur Conan Doyle authenticated by numerous publications over many years.

Much of what has been written biographically about Conan Doyle has relatively ignored the deeply ingrained aspects of his medical training and its effect throughout his writings and life. Rodin and Key not only tread on fresh ground, they plowed it deeply, and provide a unique look at Conan Doyle. And unlike most biographies, often written to tell a good story aided by liberal literary license, their account provides extensive, accurate and detailed documentation of the multitude of events they describe.

The book contains three general sections, each with two chapters. Section One considers Arthur Conan Doyle as medical student and practitioner, and his medical writings. Section Two discusses his medical and nonmedical fiction. Section Three concerns itself with medical events related to Conan Doyle, Sherlock Holmes, and Dr. Watson. Then follows a reconsideration of Dr. Conan Doyle, forty pages of notes of additional information about many of the previous comments, and thirty-five pages of appendices listing the subject’s medical chronology, medical writings, Edinburgh’s faculty and Conan Doyle’s medical school grades, the non-Sherlockian doctors, and medical references in the Sherlock Holmes stories. There are sixty pages of documentation listing 947 entries, and 22 illustrations.

One cannot exaggerate the detail and comprehensive manner in which Rodin and Key portray each subject; they describe not only Conan Doyle’s activities, but also present extensive background information, as for example the history of the towns in which Conan Doyle practiced, of the diseases discussed, and the doctors presented, etc. As a result there are few questions left unanswered about Conan Doyle’s medical life and its relation to his writings and activities. Only a little new information has been found since this book’s publication.

Along the way Rodin and Key carefully and repeatedly document Conan Doyle’s thoughtfulness in his dealings with people and social causes. This viewpoint like the medical events depicts a new aspect of Conan Doyle, since other biographies have devoted themselves more to occurrences themselves rather than his closer, more personal actions.

For many years, Conan Doyle’s attendance and graduation from the University of Edinburgh with the degrees of B.M. (Bachelor of Medicine) and C.M. (Master of Surgery), and his attainment of an M.D. degree four years later, were acknowledged in but casual fashion. That he practiced medicine for eight years in Southsea was mentioned, along with his brief venture as an ophthalmologist in London. But these were spoken of disparagingly, e.g. ‘he left medicine because his practice was insufficient,” and mentioned only in relation to the chronology of his literary activities. His obituaries in 1930 essentially ignored the medical part of his life, only one giving a reasonable view of his medical activities and their influence on his literary efforts. His son Adrian’s The True Conan Doyle gives no attention to his father’s medical activities except to minimize the role of Dr. Bell as the prototype for Holmes. Even the medical profession in general disparaged Conan Doyle as a doctor. The British Medical Journal’s obituary of him stated:

He was one of many writers who have started out to make a career in medicine, and under the impulse of a creative spirit abandoned practice for the life of letters. . . he practised obscurely at Southsea . . . They were lean years . . . In the dull interludes of shabby-genteel practice he polished up his talent for writing, and from time to time short stories from his pen would be accepted by editors of magazines.

Wrong, as Rodin and Key demonstrate, but the common attitude.

Conan Doyle has always been overshadowed by Sherlock Holmes, but Rodin and Key clarify how the rigorous and demanding years in medical school, the hours spent day and night with sick people observing their suffering, their joys and their deaths, were the source of many memories and impressions that found expression in Conan Doyle’s writings. Rodin and Key show how these experiences, combined with his plethora of interests, provided a full palette for his brush. Other authors have written about medicine — the diseases, doctors, treatments, disabilities, etc. — but none as effectively as Conan Doyle. More than any other writer, he deserves credit for introducing the medical genre into literature and to the reading public.

Conan Doyle came from family distinguished as artists on the paternal side. His only medical relative was his maternal grandfather, William Foley, M.D., who died relatively young. Conan Doyle’s parents married early and produced a large family. His father became progressively more addicted to alcohol, and his mother the prop of the family. Conan Doyle’s decision to become a physician was prompted in part by Dr. Bryan Charles Waller, who boarded with them.

Edinburgh was an outstanding school. Its faculty was renowned, and Conan Doyle’s years there were filled with talk of a philosophy of rational thinking —Darwin, Mendel, and others fueling a new scientific approach that was instilled in the young students’ minds. One of his teachers in surgery, Dr. Joseph Bell, stood out from the others by his dynamic style of teaching and a diagnostic acumen based on close observation. Conan Doyle applied and was accepted as a clerk to assist Bell in his out-patient clinics, a most profitable and far-reaching experience.

To earn money, Conan Doyle spent seven months as surgeon on a whaling ship in the Arctic. He also worked as an assistant to three physicians in the Midlands, Drs. Richardson (Shropshire), Elliot (Shropshire), and Hoare (Ashton Manor), acquiring much background for subsequent stories.[2] Three short stories were published by Conan Doyle while still in medical school, plus a medical letter (“Gelseminum as a Poison”) in the British Medical Journal in 1879, reporting from observations on himself about the effects of increasing doses of a drug prescribed for neuralgia. He found time for an occasional poem such as “The Medical Love Song,” most likely written to a young lady whom he was seriously considering for marriage. (His anatomy and physiology go slightly awry in the latter since the mitral valve is on the right side and the heart contracts with systole rather than diastole.)

The Medical Love Song

My heart at each systole swelling

Still murmurs its passion for you —

The Venous side, dear, is thy dwelling,

A temple untainted and true

And there by the fossa ovalis

Where the mitral your chamber shall screen,

There ’mid reduced haemoglobin

Oh that is your palace, my queen. [3]

Edinburgh was later epitomized in The Firm of Girdlestone as:

a great unsympathetic machine, taking in a stream of raw-boned cartilaginous youths at one end, and turning them out at the other as learned divines, astute lawyers, and skilful medical men. Of every thousand of the raw material about six hundred emerge at the other side. The remainder are broken in the process. . . . those whose manliness and good sense keep them straight have gone through a training which lasts them for life. . . They have learned self-reliance, confidence, and, in a word, have become men of the world while their confreres in England are still magnified school-boys.

In Victorian times, becoming a member of the medical profession did not automatically assure prestige and wealth. To obtain additional finances for a start in practice, but also because of Conan Doyle’s natural propensity for adventure, he took yet another sea job after receiving his B.M. & C.M. in 1881. This voyage along the west coast of Africa as ship’s surgeon provided further material for stories. Then began the search for a place to practice medicine. The first was in Plymouth with a recent graduate, Dr. George Budd, his senior at Edinburgh by one year. They separated abruptly in several months, and Conan Doyle went to nearby Southsea, a suburb of Portsmouth: experiences well-portrayed among the short stories of Round the Red Lamp (1894) and in The Stark Munro Letters (1895).

During eight years at Southsea, his practice, slow at first, gradually increased. Writing produced welcome additional income; he also engaged in sports and other non-medical activities — the Portsmouth Literary and Scientific Society, the Masonic Lodge, and the Liberal-Unionists. Between graduation in 1881 and the start of his practice in Southsea, four short stories and two articles on photography appeared in print. But by the time he left Southsea, eight years later in December 1890, there were about thirty fiction stories, five novels, a medical thesis, and at least fifteen medical and nonmedical magazine articles and letters to newspapers. The topics were varied: leucocythemia, syphilis, contagious disease legislation, American medical education and its worthless diplomas, gout, compulsory vaccination for small pox, Koch’s alleged cure for tuberculosis, and a popular magazine article, “Life and Death in the Blood.”

His M.D. was granted in 1885 one month before his marriage to Louise Hawkins. “After my marriage,” he remarked, “my brain seems to have quickened and both my imagination and my range of expression were greatly improved.” In 1887 Sherlock Holmes made his first appearance, and Conan Doyle’s life was soon to change. The Sign of the Four (1890) further enhanced the characters of Holmes and Watson. The White Company and Raffles Haw were completed before his departure from Southsea, although not published until 1891 and 1892 respectively.

His curiosity about Koch’s claims about tuberculosis prompted him to visit Berlin for a firsthand look. On this trip a London dermatologist, Malcolm Morris, urged him to leave his small town and come to London. Rather abruptly Conan Doyle took this advice, to specialize in ophthalmology after several months’ training in Vienna. (While, he wrote to his sister Lottie, “keeping literature as my milk-cow.”) His stay in Vienna was brief — about two months, much of that spent writing Raffles Haw. Nevertheless he acquired considerable knowledge about the eye, later displayed in his writings. In London he rented an office near medically fashionable Harley Street, but by his account, no patients came; with no one in the waiting room, he had more than ample time for writing. One month after he began practice he had a severe bout of influenza, and in the quietness of reflection that accompanies a serious illness:

It was then, as I surveyed my life, that I saw how foolish I was to waste my literary earnings in keeping up an oculist’s room in Wimpole Street, and I determined with a wild rush of joy to cut the painter and to trust for ever to my power of writing. I remember in my delight taking the handkerchief which lay upon the coverlet in my enfeebled hand, and tossing it up to the ceiling in my exultation. I should at last be my own master.

Rodin and Key write: “Conan Doyle at last committed himself to his true vocation, but one which was to be inextricably influenced by previous experiences.”

There was a further medical experience ten years later. Conan Doyle became emotionally involved with the Boer War. Turned down for military service because of age, he became a voluntary physician with Langman’s Hospital in Bloemfontein, South Africa, arriving in Capetown on March 21, 1900, to begin one of the major episodes of his life, politically and medically. His experiences there resulted in several accounts: The Great Boer War (1900), an article in the British Medical Journal about enteric fever (1900), and The War in South Africa (1902). Perhaps most important was his understanding of the etiology, epidemiology and prevention of enteric (typhoid) fever, resulting in a marked change in military policy in the crowded and irregular conditions of war. He vigorously supported preventive inoculation, something loudly and vigorously disputed by Bernard Shaw. Both were equally prominent authors, but Conan Doyle brought more scientific and medical understanding to the subject.

After the Boer War, Conan Doyle continued his friendship with medical organizations, giving frequent toasts at various medical societies and a reception for the British Medical Association at his home in 1913. Politically he supported the Daylight Saving Bill of 1908 as likely to increase the general standard of health, particularly for children. Venereal disease from prostitution gained his attention, and he spoke out forcefully against opponents of the Contagious Disease Act. He spoke and wrote on behalf of the humanitarian treatment of the Congo’s natives, criticizing the “civilized nations” who had seen “a hapless race, whose safety they have guaranteed, robbed, debauched, mutilated and murdered, without raising a hand or in most cases even a voice to protect them.” And he continued to support vivisection, a raging quarrel in Victorian times as at present. Statements that there was not “an atom of evidence” that any lives had been helped by the torture of animals quickly drew a response to the contrary from Conan Doyle. But he was equally opposed to animal cruelty; his autobiography refers to Professor Rutherford at Edinburgh as “a rather ruthless vivisector, and though I have always recognized that a minimum of painless vivisection is necessary, and far more justifiable than the eating of meat as a food, I am glad that the law was made more stringent so as to restrain such men as he.”

His ophthalmological knowledge benefitted George Edalji, convicted of maiming horses and cattle, with Conan Doyle’s cogent arguments about Edalji’s ophthalmologic problems, in letters to Lancet and the British Medical Journal, contributing to Edalji’s release from prison. In later life, Conan Doyle was to utilize his medical resources in his Spiritualistic activities, by measuring changes in pulse rate in various mediums. In his Spiritualism he remained unconvinced of spirit healing, accepting some cases, but not abandoning his deeply ingrained beliefs in biologic theory and medicine: “While in Boston I spent an hour or so in the magnificent temple of the Christian Scientists. I confess that I have little sympathy with these people. . . . Faith healing and healing by what we now call suggestion are as old as history.”

iii

In an opening address to St. Mary’s Medical School in London that he gave in 1910, Conan Doyle addressed a theme which Rodin and Key are at pains to emphasize in their coverage of the role medicine played in his life and literary work: humanism and idealism in medicine, as expressed in his public actions and fictional writings:

the value of kindliness and humanity as well as of knowledge. . . . A strong and kindly personality is as valuable an asset as actual learning in a medical man. I have known men in the profession who were stuffed with accurate knowledge, and yet were so cold in their bearing, and so unsympathetic in their attitude, assuming the role rather of a judge than a friend, that they left their half-frozen patients all the worse for their contact.

And he admonished the students:

Unselfishness, fearlessness, humanity, self-effacement, professional honour — these are the proud qualities which medicine has ever demanded from her sons. They have lived up to them. It is for you youngsters to see that they shall not decline during the generation to come.

Rodin and Key show repeatedly how Conan Doyle displayed medical “humanism,” even under the worst of conditions, quoting an observer of his medical work in during the Boer War:

It was difficult to associate him with the author of Sherlock Holmes: he was a doctor pure and simple, an enthusiastic doctor too. I never saw a man throw himself into duty so thoroughly heart-and-soul. . . He threw open the door of one of the . . . wards, and what I saw baffles description. The only thing I can liken it to is a slaughter house. It fascinated me to watch their cheery doctor carrying the sunshine with him wherever he went, worshipped by all.

Rodin and Key summarize his actions at this time: “Tales of horror crowd upon one; stories of men in delirium, wandering about the camp at night; stories of living men in the agonies of disease, with dead men lying on either side.” It was in such a hell that Conan Doyle managed to maintain his equilibrium and his human sensitivity. This was not true of some others. At one point he settled a serious dispute, close to mutiny, between Major Drury and many of the supporting staff.

It was a medical recognition of Conan Doyle at the time to be invited to address the opening of St. Mary’s Medical School. His talk, “The Romance of Medicine,” reflected many of his experiences as a physician, his philosophy — the view that medicine “tinges the whole philosophy of life, and furnishes the whole basis of thought” — and the effect of disease on historical events. As he told his audience, “I am not an amateur, and . . . there are few phases of medical life, from the sixpenny dispensary to the two-guinea prescriptions, that I have not had personal experience.” Detailed dissection of a human being from scalp to toes provides not only a large and remarkable fund of knowledge — it also develops the basis for an uniquely intimate relationship with people and their lives. The physician is taught to be dispassionate in his treatment, but the overpowering dismay and feeling of helplessness when a patient’s disease relentlessly progresses to death exceed that of any other profession. Medicine follows rigid methods, and the physician must be methodical, compulsive, even obsessive, in his thoughts and actions. Whether the patient is rich or poor, pleasant or nasty, calm or angry, responsive or not, the responsibility, accountability, and worry impacts the physician throughout every hour of the day. There is little opportunity for creativity. Expressions of inner thoughts and feelings must be controlled and repressed. With Conan Doyle, the genes of creativity were well-established; they blossomed naturally in his writing, and proved more satisfying to him; but years of medicine emerged frequently in his writings.

There is another aspect to which Rodin and Key give consideration. For people subjected to emotional trauma in their childhood or teen years, such trauma often remains unresolved. The distortion trauma causes can emerge from the subconscious or unconscious in numerous ways. It can stay submerged but break forth at intervals toward others or themselves. It can form an inappropriate type of behavior toward others, displaced into pathways equally inappropriate and often destructive for themselves (drugs, alcoholism, gambling, etc.), or it can be sublimated and dissipated by creative efforts (writing, art, etc.). Conan Doyle’s writings are compatible with the last such management of his childhood experiences — memories of his family’s crowded home and relative poverty in Edinburgh, and his father’s alcoholism perhaps accompanied on occasion by physical abuse.

Rodin and Key list fifty-eight nonfiction and fiction titles by Conan Doyle between 1879 and 1928. There are 118 doctors mentioned in his short stories and novels, fifty-five in the medical short stories and novels, sixty-three in the nonmedical writings. For the most part his doctors are not main characters. They add lustre and interest to the plots, but usually receive only casual attention, doctors and diseases serving as cameos for the central themes:

More usually physicians who become serious writers abandon the clinic wholly or visit it only intermittently. But they retain the clinician’s way of looking. Their writing carries that special imprint peculiar to those who have felt, smelled and dwelled among fevers, madness, blood and abscesses.

The distinguishing feature of Doyle’s writings was that he knew how to tell a story in an interesting fashion. His imagery stimulates, his style is graphic and his descriptions are vivid. His medical scenes portray the basic sciences, clinical information, and doctors of his times.

Rodin and Key arrange Conan Doyle’s medical literary topics and allusions into five areas: medical writings; medical fiction; nonmedical fiction; detectives, doctors and diseases; drugs and detection. The total number of medical expressions is quite numerous, more so than with any other author.

Conan Doyle’s medical fiction ranged from the years 1884 to 1911 with the majority written before 1900. When he ceased medical practice and became interested in more fields, so did the number of his medical references in writing become less. Fifteen of his eighteen medical short stories were published in Round the Red Lamp by 1894, covering a wide range of topics — the life of a medical student, starting a medical practice, episodes of practice, the emotional problems of dealing with patients, a love story involving a female physician, several of cuckoldry and the husband’s retaliation, insanity and porphyria, the pain of childbearing, inheritable diseases, and vogues in therapy — electrotherapy and hypnotism. In them were moments of humor, some self-deprecatory, as related by Rodin and Key:

The enormous interest in Sherlock Holmes and Dr. Watson and the zeal displayed in the magnitude of commentaries about these stories have obfuscated a realistic perception of Doyle and his medical references in the Canon. Certainly the genesis of this famous couple was based on the people Doyle encountered in his medical school days, particularly Dr. Joseph Bell and at least the two Dr. Watsons that he met, one Dr. Patrick Heron Watson, an Edinburgh graduate, and a Dr. James Watson, practicing at Southsea. The dermatologist Malcolm Morris reportedly drilled and tested Doyle on the value of minute observation and what could be deduced thereby. But credit has been given and accepted by Doyle’s surgical teacher at Edinburgh as Conan Doyle acknowledged: “I thought of my old teacher Joe Bell, of his eagle face, of his curious ways, of his eerie trick of spotting details. If he were a detective he would surely reduce this fascinating but unorganized business to something nearer to an exact science.”

Detective fiction was just emerging in the Victorian era with the stories of Edgar Allan Poe, Emile Gaboriau, Fergus Hume, R. Austin Freeman and Wilkie Collins. But the greatest appeal and best characterization belonged to Sherlock Holmes who provided a new configuration, almost forcing the others off-stage. Conan Doyle’s plots were unusual and had the ability to hold readers’ interest. There are a great number of medical references in the Sherlock Holmes stories, with thirty-four physicians and two professors, of physiology and of comparative anatomy. Most are general practitioners. Almost all the physicians (save Watson) are peripheral, reinforcing the background, flitting in and out of the stories in various roles, and sharpening the readers’ attention. Rodin and Key illustrate how Conan Doyle adopted many of his own experiences in describing these physicians.

Of equal interest although not as frequent are Conan Doyle’s accounts of forensic medicine: a test for blood, footprints, fingerprints, changes in the body after death, and deductions based on trauma in various parts of the body. Sir Henry Littlejohn, one of his professors at Edinburgh, was also the City of Edinburgh Police Surgeon, in the years when forensic pathology was becoming established as a medical specialty and science.

Conan Doyle left a lifetime of diverse activities that almost defy description — sports, champion for the unjustly accused, patriotic efforts, war historian, an advocate of the divorce rights of women, and a major player in Spiritualism. His medical comments described the knowledge of his time but often made surprising predictions about the future of medicine. Rodin and Key show how his excellent medical knowledge, an insatiable curiosity, a vivid imagination, and the artistry of expression combined with his sympathy for humanity to produce a remarkable and memorable author.

Most of this outstanding book resulted from their minute and careful search in newspapers, journals, and books. There are a few personal letters from library collections. Dame Jean Conan Doyle, his only living child, aided by her encouragement and personal recollections. Rodin and Key later added to their initial presentation with their commentaries on Conan Doyle’s Tales of Medical Humanism and Values [4], containing Round the Red Lamp, six other medical short stories, and “The Romance of Medicine.” It is doubtful if any further significant information about medicine and Conan Doyle’s writings will be found when the family archives are finally released for scholarly use again.

NOTES

1. Malabar, Florida: Krieger Publishing Co., 1984.

2. Paul Lester has provided additional information about these experiences in his book Sherlock Holmes in Birmingham, Studley, Warwickskire: Brewin Books, 1989.

3. From the Arthur Conan Doyle Archives at Bibliotheque Cantonale et Universitaire Lausanne-Dorigny.

4. Malabar, Florida: Krieger Publishing Co., 1992.

Editor’s Note

Fred Kittle is a notable bookman in addition to his long and distinguished career as a thoracic surgeon. Two years ago he was honored by a lengthy profile in the monthly periodical of The Caxton Club, Chicago’s century-old bibliophile society. A long-time collector and scholar of Doyleana — not only Dr. Conan Doyle, but the other artistically gifted members of that family — he also figured in 2002’s book Among the Gently Mad: Strategies and Perspectives for the Book-Hunter in the 21st Century by Nicholas A. Basbanes. His collection of Doyleana is now at Chicago’s Newberry Library, which in its honor hosts a Conan Doyle symposium on the Saturday morning following each year’s Hounds of the Baskerville (sic) annual dinner in Chicago. Dr. Kittle is “Jack Stapleton” in the BSI.