“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.
A swimmer exposed to the tentacles of these large jellyfish may,
according to Klein and Bradshaw, suffer pain, swelling, and redness
in the affected part. In a few minutes to an hour following exposure,
systemic effects may appear, such as anxiety, muscular pains and
cramps, dyspnea, constriction of the throat, cardiac symptoms, and
prostration. The authors stress that the alarming symptoms which often
follow stings from coelenterates suggest the action of a powerful
neurotoxin.
Waite,[3] writing in the same year, stresses the fact that contact with
a Portuguese man-of-war produces symptoms indicative of anaphylactic
shock, such as pallor, sweating, faintness, fall in blood pressure, and
the like. He mentions that although there have been no authenticated
medical reports of death as a result of the sting of a Portuguese
man-of-war, it could happen if complicated by anaphylactic shock.
One wonders, of course, what would have happened if the patient
described by Klein and Bradshaw had been some distance from shore.
If anaphylactic shock had occurred within a few minutes, the patient
no doubt would have drowned if no one had been in the vicinity to
help him. A swimmer who experiences difficulty in breathing, who is
afflicted with severe abdominal cramps, who shows signs of shock, and
who is mentally confused, will certainly drown. Indeed, any one of
these four symptoms could provoke disaster in deep water.
The treatment instituted by Klein and Bradshaw is worthy of our
attention. The patient was hospitalized and given calcium gluconate
and benadryl intravenously. Epinephrine and atropine were administered
intramuscularly, and ammonia applied locally. I might add that a purist
could raise the question whether all this medication was necessary. The
next day, the itching areas were treated with tetracaine. The patient
made an uneventful recovery, although it took about three weeks before
the lesions were healed. Waite emphasizes that, in case of anaphylactic
shock, epinephrine or benadryl should be given immediately. He warns
further that if angioneurotic edema appears, the air passageways
should be cleared, oxygen supplied, and, if necessary, a tracheotomy
performed. The latter constitutes heroic treatment, but may, of course,
save a person’s life.
Let us return to _The Adventure of the Lion’s Mane_, in an attempt
to ascertain what medical agents were used fifty years ago to treat the
sting of coelenterates. As previously mentioned, Sherlock Holmes was in
retirement and living alone, so unfortunately he could not call upon
his friend Dr. Watson to prescribe for Ian Murdoch.
Holmes, however, rose to the occasion and made an earnest attempt to
help the patient, for he writes that he soaked cotton in salad oil and
applied it to the wounds. He felt that this greatly alleviated the
pain. The famous detective showed real ingenuity in making use of such
a homely remedy. He also gave the suffering man liberal quantities of
brandy, which doubtless had a narcotizing effect. There is considerable
evidence that brandy was widely used for medicinal purposes at the turn
of the century, when this adventure is supposed to have occurred.
It is of interest to speculate upon what medication Dr. Watson would
have administered to Ian Murdoch had he been in attendance. At that
time, neither benadryl nor calcium gluconate nor, for that matter,
tetracaine was available. On the other hand, epinephrine, atropine,
and ammonia were even then widely used. Dr. Watson presumably would
have given a hypodermic injection of morphine and offered the patient
brandy, as did Sherlock Holmes. He, too, doubtless would have applied
some soothing ointment to the painful lesions, or, like Klein and
Bradshaw, might have used ammonia. It is even possible that he would
have employed epinephrine. The latter certainly was indicated, for
the symptoms described by Holmes were those of anaphylactic shock.
This syndrome (anaphylactic shock) was not well understood fifty years
ago. In point of fact, the word “anaphylaxis” was coined in 1907 by
Richet. This, as mentioned earlier, was the year when the adventure was
supposed to have taken place. Holmes, however, wrote _The Adventure
of the Lion’s Mane_ probably in 1925, since it was first published
in 1926. At that time, the significance of anaphylactic shock in man
was pretty well understood, and it is possible that he was familiar
with this condition.
It is a pity that we have to resort to speculation, and that Dr. Watson
was not in attendance instead of Holmes, a nonmedical man. If such
had been the case, Watson probably would have mentioned the agents
medical men used at that time. This would not only have satisfied our
sympathetic curiosity but, what is more important, these facts would
have been of historical interest. We then could actually have compared
the medical agents which were prescribed fifty years ago with those
currently employed for the grave symptoms of shock produced by the
excruciatingly painful stings of coelenterates.