“... 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.