“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.