“... the thin white hand he laid on the mantelpiece ... was that of an
artist rather than of a surgeon.”
_The Resident Patient_
Dr. Watson professed to be a general practitioner of medicine. Such a
person is called upon from time to time to do minor, but under ordinary
conditions he does not attempt to do major, surgery. To my knowledge,
there is no particular reference to major surgery in any of the tales,
although one or two famous surgeons are mentioned. On the other hand,
numerous allusions are made to minor surgery. I am cognizant of the
fact that there is often but a thin line between major and minor
surgery.
Dr. Watson evidently felt that a good surgeon must have large and
supple hands, for he writes: “... the thin white hand he laid on the
mantelpiece ... was that of an artist rather than a surgeon” (_The
Resident Patient_). The size of the hand probably is not of major
importance. It is the ability to use the hands that counts. Several
eminent surgeons, to my own knowledge, are men of large physical
stature, and I am sure have correspondingly large hands. But I have
seen some equally capable men, hardly of average height, who had small
hands. Harvey Cushing, the brilliant Harvard brain surgeon, was a man
of medium size, and, if I recall correctly, had rather small hands. Let
us not labor this point further, for this is not an essay on surgeons’
hands, but turn to the tales of Sherlock Holmes.
It is axiomatic that every man who practices medicine, regardless of
his specialty, must be familiar with the current literature in his
field. It is gratifying that Dr. Watson appreciated this. In _The
Adventure of the Golden Pince-Nez_, Watson observes that one stormy
night he and Holmes sat together in silence; the latter was working on
a palimpsest, while Watson was reading a treatise on surgery.
Holmes appreciated that a correct diagnosis is of paramount importance
to a conscientious surgeon. In _The Problem of Thor Bridge_, we
find Mr. Neil Gibson, the “Gold King,” telling Holmes that he was
like a surgeon, because Holmes wanted to know every symptom before
he ventured a diagnosis. Holmes quickly retorted that this was quite
true, and strongly implied that his client was withholding important
information which Holmes needed before the mystery about which he was
being consulted could be solved.
There are a number of references to scalp wounds or injuries to the
skull, or both. In the rough-and-tumble life a detective leads, it
might be expected that he would often see such injuries. Let us examine
some of them.
Once Sherlock Holmes himself came under a surgeon’s care. The great
detective had been attacked on the street by two ruffians and had
been pretty roughly handled (_The Adventure of the Illustrious
Client_). Sir Leslie Oakshot, the eminent London surgeon who had
been called in, stated that Holmes had suffered lacerations of the
scalp and that several stitches were necessary. Holmes fortunately made
an uneventful recovery, and we learn that the stitches were taken out
on the seventh day.
Dr. Watson describes a man in _The Adventure of the Solitary Cyclist_
who had suffered a severe scalp wound. He had been found unconscious,
although the bones of the skull had not been penetrated. Another case
is mentioned which surely must puzzle the layman (_The Adventure
of the Dancing Men_). A bullet passed through the frontal portion
of the brain. The reader is assured that, although the patient was
unconscious, she would live. The medically trained person would think
immediately of an accidental lobotomy.
One is reminded in this connection of the skull of a workman exhibited
in the museum of the Harvard Medical School. This rare specimen shows
an enormous hole made by a tamping bar. The bar passed through the
skull, and a considerable amount of brain substance was destroyed.
Remarkably enough, the patient did not die from this terrific injury,
but lived for a long time afterward--surely a most unusual case.
It should be added that he suffered an unfortunate change in his
personality following the accident.
In several instances, the head injuries mentioned were immediately
fatal. For example, in _The Adventure of the Empty House_, an
expanding revolver bullet was fired into the victim’s head. In _The
Boscombe Valley Mystery_, we find that: “The head had been beaten
in by repeated blows of some heavy and blunt weapon.” In this last
story, Dr. Watson gets technical: “In the surgeon’s deposition it was
stated that the posterior third of the left parietal bone and the left
half of the occipital bone had been shattered by a heavy blow from a
blunt weapon.” But contrast the following nontechnical description:
“The injury from which the unfortunate veteran was suffering was found
to be a jagged cut some two inches long at the back part of his head,
which had evidently been caused by a violent blow from a blunt weapon”
(_The Crooked Man_). This is a good example of a wound so simply
described that anyone could easily understand and appreciate it. With
few exceptions, Watson never forgot that he was writing for laymen.
Scalp wounds and injuries to the head are often used to dramatize
detective stories. The average layman instinctively feels that such
wounds are extraordinarily dangerous, and that people experiencing such
accidents are nearly always in a critical state. This, of course, may
or may not be true, because nature has provided a strong bony cage to
protect the brain.
In _The Adventure of the Sussex Vampire_, there occurs a reference
concerning an orthopedic problem. Dr. Watson writes that the gait of
a fifteen-year-old boy suggested plainly that he had a weak spine. We
are further informed that a fall in childhood had brought about this
condition. The devoted father spoke of the lad as being an unfortunate
cripple and quite inoffensive. He was quite mistaken, for this
so-called inoffensive lad became so insanely jealous of his normal,
healthy baby half-brother that he tried to do away with him by use of
curare, the South American Indian arrow poison. When Holmes unearthed
this diabolic scheme, he reluctantly informed the boy’s unsuspecting
father. Holmes prefaced his remarks by stating that he was a busy man
and would come to the point quickly; and he used the simile that, the
swifter surgery is done, the less painful it is.
The idea Holmes expressed in regard to swift surgery holds our
interest. In the early days, before the discovery of ether, surgeons
for obvious reasons attempted to perform operations in the shortest
possible time. Indeed, the skill of a surgeon was largely gauged by the
speed with which he could perform an operation.
In at least two of the tales, the carotid artery was the focal point
of interest. In _The Adventure of the Creeping Man_, we find that
when Professor Presbury was viciously attacked by his wolfhound, the
teeth of the dog narrowly missed the carotid artery. In spite of the
rather severe hemorrhage which followed, it will be recalled that the
professor recovered. In _The Adventure of the Golden Pince-Nez_,
the victim was not as lucky. His carotid had been severed by an
old-fashioned sealing-wax knife, and death ensued in a short time.
Watson emphasized that the wound was small but deep. He was aware that
a large blunt instrument might have pushed the elastic artery aside
rather than piercing it.
We find one reference to an amputation, although it was not performed
by a surgeon. Early one morning, there appeared in Dr. Watson’s
consultation room a young engineer who, during the preceding night, had
undergone a harrowing experience in which his thumb had been hacked off
by a vicious counterfeiter. The doctor was astounded when he saw the
wound: “It gave even my hardened nerves a shudder to look at it. There
were four protruding fingers and a horrid, red, spongy surface where
the thumb should have been. It had been hacked or torn right from the
roots” (_The Adventure of the Engineer’s Thumb_).
When Dr. Watson asked the victim whether the wound had bled a
great deal, the answer was: “Yes, it did.... I tied one end of my
handkerchief very tightly around the wrist and braced it up with a
twig.” Watson’s succinct reply was: “Excellent. You should have been
a surgeon.” To satisfy the reader’s sympathetic curiosity, it should
be mentioned that Dr. Watson gave the patient a drink of brandy, and
cleansed and bandaged the wound. Since the thumb had been “torn right
out from the roots,” it seems that Dr. Watson should have taken a few
stitches to bring the cut tissues together. No such mention is made,
and it is to be hoped that the wound healed satisfactorily.
It is noteworthy that this engineer must have had a rugged
constitution. Dr. Watson, after caring for the wound, took him to 221B
Baker Street, where he joined Holmes and Watson in eating a substantial
breakfast. Then, for the benefit of the consulting detective, he
related the night’s terrible adventure at some length. He next
accompanied Holmes and his companions on a train journey to Eyeford, a
little Berkshire village. This was a strenuous program. The question
arises, why did the kind Watson allow his patient to do all these
things? This young man should have received a narcotic to deaden the
pain, which must have been severe, and then should have gone to bed. If
the patient experienced difficulty in going to sleep, a hypnotic should
have been administered. In this instance, Dr. Watson placed himself in
an indefensible position.
Let us now turn from injuries of the human flesh and consider something
relatively less gruesome. A surgical instrument is described and,
interestingly enough, the name of the manufacturer is given. Holmes
himself calls our attention to it: “... an ivory-handled knife with a
very delicate, inflexible blade marked Weiss & Co., London” (_Silver
Blaze_). Parenthetically, it should be stated that Weiss & Co.,
are still famous makers of knives. Indeed, there are several in my
laboratory at the present time.
When Holmes speaks of the singularity of this knife, and suggests to
Dr. Watson that surely this was in his line, the latter states, “It is
what we call a cataract knife.” Holmes replies, “A very delicate blade
devised for very delicate work.” The reader should be reminded that
the knife in question was not employed to murder a human being, but a
villainous horse trainer had intended to use it to cut the tendon of a
famous race horse. It will be remembered that the nefarious scheme was
never carried out, for the highly nervous thoroughbred animal killed
his trainer by kicking him on the head before the operation could be
performed.
As far as I am aware, Watson did not make any specific mention of any
other surgical instruments in the tales. He does, however, on one
occasion make an allusion to a surgeon’s choice of his instrument
during an operation. He is commenting on Holmes’ selection of tools
when attempting to open the safe of the notorious blackmailer,
Charles Augustus Milverton, and points out that Holmes chose his
instruments with the same scientific precision as a surgeon about to
perform an important operation (_The Adventure of Charles Augustus
Milverton_).
In the present essay, we have discussed only those cases which are
concerned with surgery. But in England the medical man is often
spoken of as a “surgeon,” rather than a physician or a doctor or a
general practitioner. We find such expressions in the Sherlock Holmes
stories: “And here comes the country surgeon ...” (_The Adventure
of the Copper Beeches_). Numerous other references could be cited,
but this one will suffice. Furthermore, a doctor’s treatment room is
spoken of as his “surgery.” This latter expression is often found,
especially in English novels. The villain Stapleton, in _The Hound of
the Baskervilles_, tells Dr. Watson that he had been visiting with
Dr. Mortimer, and that while they were in his “surgery,” Dr. Mortimer
had pointed out Dr. Watson through the window. In another instance,
we find, “The surgery, where I used to make up my drugs ...” (_The
Sign of the Four_). In this country, we would simply call it “the
doctor’s office,” or if we wanted to be more specific, his “treatment”
or “examining room.” These are minor differences, it is true, but they
are of passing interest.
Some of the wounds so dramatically described by Dr. Watson surely
became severely infected, and the patient’s suffering must have been
considerable. Pasteur and Lister had already published the results of
their brilliant researches, and the medical profession was well aware
of the dangers of infections at the time. In spite of this, not much
could be done once the wounds began to suppurate, for the antibiotics
had as yet not been discovered. We may rest assured, however, that Dr.
Watson did all he could to alleviate the patient’s pain and to promote
healing of the wound.