Dr Conan Doyle, A Victorian Physician and Practitioner
Dr Conan Doyle, A Victorian Physician and Practitioner is an article written by Chris Wills-Wood published in the A.C.D. - The Journal of The Arthur Conan Doyle Society (Vol. 3, 1992).
This article reassesses Arthur Conan Doyle as a Victorian physician, examining his clinical writings, public health advocacy, medical fiction, and Boer War service to challenge the myth that he was a failed doctor. It concludes that he was neither exceptional nor incompetent, but a competent and humane general practitioner whose medical experience deeply informed his literary work.
Dr Conan Doyle, A Victorian Physician and Practitioner
Tunbridge Wells 1992
Conan Doyle the physician has been overshadowed by Conan Doyle the author, who achieved world wide fame as the creator of Sherlock Holmes. The physician has languished in the shadow of his creation, and from that shadow have come myths about Conan Doyle the doctor which usually depict him as a failure. An examination of Conan Doyle's medical letters, articles, and fiction reveals some of his skills as a medical practitioner, as well as some of his philosophy on medicine and medical practice. His experiences in the world of medicine, as both student and practitioner, were drawn upon in his medical fiction, and used as the basis for the medical characters he drew in his non-medical fiction.
Auto-Experimentation with Gelsemium
Conan Doyle's first medical publication was a letter in the British Medical Journal (BMJ) in 1879, written when he was a third year medical student, and titled 'Gelsemium as a Poison.' (1) It recounted his auto-experimentation with gelsemium to relieve what he described as 'persistent neuralgia.' The experiment lasted for a week, during which time he recorded the clinical effects an increased daily dose of gelsemium had on him. From these observations he drew a number of conclusions.
One the first day (Monday) he took an initial dose of 40 minims. By the fifth day (Friday) he was taking a dose of 150 minims, and recording the clinical symptoms of severe frontal headache, with diarrhoea and general lassitude. On the sixth and seventh days, when he took a dose of 200 minims, he recorded 'great depression and a severe frontal headache. The pulse was still normal but weak.' In his conclusions Conan Doyle stated that a 'healthy adult may take as much as 90 minims with perfect immunity': this when he knew that 75 minims had been shown to be a fatal dose. His fourth and final conclusion ends: 'I feel convinced that I could have taken as much as half an ounce of the tincture [of gelsemium] had it not been for the extreme diarrhoea it brought on. This is a disappointingly poor conclusion to put forward, as the severe diarrhoea, which had laid him prostrate, would have contra-indicated this on clinical grounds.
In his book The Real World of Sherlock Holmes, Peter Costello mentions this auto-experimentation as being carried out 'in a simple spirit of experiment.' This is too simplified a view. At this period auto-experimentation was carried out by many physicians and scientists who sought to find medical answers by a scientific method. Many of these experimenters exposed themselves to unknown dangers in the search for their answers. Reputations were built on, and endorsed by, such procedures, and it is possible that, in his own small way, Conan Doyle wished to be seen as a fringe member of this group, especially by his student peers.
Southsea and General Practice
While in practice in Southsea in 1884, Conan Doyle had a letter published in The Lancet. Entitled 'The Remote Effects of Gout',2, it was a response to an article from the week before which had discussed the relation of certain diseases of the eye to gout. The letter is interesting, as it shows some of the depths to which Conan Doyle went in obtaining complete medical histories in his diagnoses.
A married woman had consulted Conan Doyle, complaining of intense pains in her eyes and partial blindness 'whenever her digestion was deranged.' Her father was already a patient, and was being treated for chronic eczema and psoriasis. From these two cases Conan Doyle went back and investigated the family history. He found that the grandfather had died from a form of Bright's disease' which he associated with gout. He concluded his letter by giving his treatment for father and daughter colchicum and alkalies — and noted that both improved rapidly on this therapy.
M.D. — Tabes Dorsalis
In 1885 Conan Doyle, like a number of his fellow practitioner colleagues, undertook a medical doctorate. His doctoral thesis was a clinically oriented review and research in tabes dorsalis, entitled 'An Essay Upon the Vasomotor Changes in Tabes Dorsalis.' In this thesis he reviewed current research on blood supply to the spinal cord and tabes dorsalis itself. At this period tabes dorsalis was not universally accepted as being caused by syphilis. Conan Doyle recognised syphilis as being the likely cause of the disease, and submitted one treatment: a 1% alcohol solution of nitroglycerin. His reasoning was that as a vasodilator it would increase the blood supply to the spinal cord, and reverse the vasospasm that occurs in tabes dorsalis.
Rodin and Key categorise Conan Doyle's thesis as a significant contribution to medicine. However, in 1880 Wilhelm Erb had presented three clinical cases of tabes dorsalis in which he had successfully improved the patient's symptoms by antisyphilitic treatment. There was no significant step forward in Conan Doyle's thesis, and I do not think it justifies such high praise or evaluation. The fact that it remains unpublished, and that Conan Doyle fails to mention it in his autobiography, may be a testament to its contribution to the history of medicine.
Public Health and Vaccination
Vaccination, and its role in the prevention of infectious diseases, was a branch of medicine that was still in its infancy in the 1880's, and was still not universally acknowledged. Conan Doyle wrote upon the role of vaccination in preventative medicine in detailed articles and letters to the press. His article 'Life and Death in the Blood', published in 1883 in Good Words, opened with a description of the morphology and functions of red and white blood cells. This was followed by an outline of the current status of research into infectious diseases, and closed with predictions of the effects vaccination would have on future generations of mankind. Rodin and Key rightly give credit to Conan Doyle for the clarity of his descriptive writing and explanations in this article. It is a good review and analysis of current concepts, and Conan Doyle voiced what all researchers were striving for. 'Given that a single disease, proved to depend upon a parasitic organism, can be effectually and certainly stamped out, why should not all diseases depending upon similar causes be done away with? That is the great question which the scientific world is striving to solve.'
During Conan Doyle's practising career there was continued resistance to the vaccination against smallpox. In 1880 the anti-vaccinationists tried to repeal the Vaccination Acts. Their opposition to vaccination was based on moral grounds and misunderstanding, and they sought and gathered support from the poorer and less well-educated members of society. The BMJ, however, orchestrated a continuous campaign against them, and Conan Doyle was one of many committed professional supporters who at a local level was a vocal spokesman through the Press. He met the challenge of one anti-vaccinationist, Colonel Wintle, who repeated the familiar moral, misinformed, and misunderstood arguments. In a letter of reply to Colonel Wintle published in The Evening Mail on 5 July, 1887, Conan Doyle described the importance of vaccination in preventative medicine: The interests at stake are so vital that an enormous responsibility rests with the men whose notion of progress is to revert to the condition of things which existed in the dark ages before the dawn of medical science. And on moral grounds he posed a question: Is it immoral for a Government to adopt a method of procedure which experience has proved and science has testified to conduce to the health and increased longevity of the population.' (3)
Conan Doyle had earlier picked up his pen in defence of the Contagious Diseases Acts, in a letter published in the Medical Times in June 1883. He expressed his fears about the consequences of suspending the Acts: For fear of delicacy should be offended where no touch of delicacy exists, dreadful evils are to result, men to suffer, children to die, and pure women to inherit unspeakable evils.' He went on to expand this further in terms of public health: 'It becomes a matter of public calamity that these Acts should be suspended for a single day, far more for an indefinite period.' (4)
These letters show his professional commitment to public health and preventative medicine issues, views endorsed by his colleagues. But underlying the professional voice there is a personal plea: to prevent needless and unjustifiable suffering and death through ignorance.
Berlin 1890
In his autobiography Conan Doyle offers no clear insight into why he decided to leave his practice at a few hours' notice to attend the Tenth International Medical Congress (IMC) at Berlin from 3-9 August 1890. He intended to attend the lectures given by Doctor Koch on his new lymph cure for tuberculosis, and was one of 6,000 people in attendance at the Convention. As Koch was one of the main attractions it is not surprising that Conan Doyle, as a late participant, failed to gain entrance to any of these lectures. He did, however, come away from Berlin with a thorough understanding of Koch's tuberculin cure. He sent a letter to the Daily Telegraph which was published on 20 November 1890 under the title 'The Consumption Cure.' This letter would have been eagerly read by people who were waiting for the news about this new lymph cure, and who were looking to Koch as their saviour from 'the captain of all the men of death.' (6)
In his letter, Conan Doyle warned an expectant public that this was not the cure for tuberculosis they anticipated. 'Koch has never claimed that his fluid kills the tubercule bacillus,' he wrote. 'On the contrary, it has no effect upon it, but destroys the low form of tissue in the meshes of which the bacilli lie. He continued, 'When one considers, however, the number and minute size of these deadly organisms, and the evidence that the lymphatics as well as the organs are affected by them it is evident that it will only be in very exceptional cases that the bacilli are all expelled. In his conclusions about tuberculin Conan Doyle expresses doubts about it re-establishing old tubercule. This was, unfortunately, to be borne out in follow-up studies. His other conclusion, about the usefulness of tuberculin for detecting tuberculosis, was also correct, and he notes that 'This alone is a very important addition to the art of medicine.'
The captain of diseases was still unconquered.
In their classic study of tuberculosis The White Plague, which examines the scientific and environmental effects tuberculosis has had on human history, Rene and Jean Dubois summarise Conan Doyle's study of Koch and his tuberculin cure as an analysis of such intelligent understanding that little of importance has since been added. It should be noted that this was written in 1952, more than sixty years after Conan Doyle's study.
As mentioned above, Conan Doyle gave no clear reason as to why he attended the IMC at such short notice. He may well have been thinking of attending for some time and felt that professional commitments to his patients prevented him; but the chance to be there for what could possibly be one of the great medical discoveries of the decade outweighed these obligations. This is perhaps an indication that he no longer felt a total commitment to general practice.
In a letter to his sister Lottie in 1888 he wrote about his thoughts of mixing a career as a London specialist in eye surgery with that of an author. One of the reasons he had not taken this step sooner was due to the fact that the decision was a difficult one. At that time the specialist was not as universally accepted or trusted within the medical profession as he is today. In 1885 Thomas Addison wrote of how he 'dreaded becoming a specialist.' (7) As late as 1903 Robert Brundell Carter FRCS, a consultant ophthalmic surgeon at St Georges Hospital London, advised readers in his book Doctors and Their Work to avoid 'specialists' and to 'seek, rather, the advice of a physician or a surgeon who regards his calling as one and indivisible, and who recognises that the whole is greater than any of its parts.'
British medical conservatism and hatred of specialists was an attitude deplored by Sir Morrell Mackenzie in 1885, but the golden age of Harley Street and its neighbouring streets of specialists was not to come until the first decade of the next century. The 'professional doctor' in him may have made Conan Doyle resist becoming a specialist, as he held some of the views and fears common to many of his medical colleagues. On the train to Berlin, however, he met a Harley Street dermatologist, Malcolm Morris. Conversation with him probably supported the ideas he had formed about a specialist practice. The reduced hours of clinical commitment it offered would give him a greater freedom to pursue his literary ambitions, which he no doubt felt were being restricted, or even stifled, by general practice.
Conan Doyle left his practice in December 1890 to specialise on the eye, but by the following June he had given this up. From the little information available on his short career as a specialist, it is possible that he may have realised very quickly that this was the wrong move professionally. Unable to face starting a general practice again, he chose to throw his lot into full time writing.
Boer War
As a direct result of having served at the Langman Hospital in Bloemfontein during the Boer War, Conan Doyle returned to England to defend the role of vaccination in preventative medicine and improve standards of hygiene and sanitary measures. This time he was not acting for the public, but for the army. He was called before the Royal Commission on the War in South Africa on 24 March, 1903, and gave evidence on the enteric epidemic which he had witnessed at Bloemfontein. He corrected the suggestion by a commissioner that the epidemic was due to exhaustion following a march, and stressed that the drinking of unfit water, such as wayside puddles, was without doubt the cause of the spread of the micro-organisms of typhoid. As a way of reforming this, he suggested that 'any break of a sanitary law ought to be a military offence.' (8)
Conan Doyle supported Professor (later Sir) Almorth Wright's antityphoid vaccine, which was voluntary and not compulsory. Conan Doyle was himself vaccinated before he went to South Africa, although only 20,000 of the 200.000 soldiers were. Wright's antityphoid vaccination was not to be included in the vaccinations given to new recruits after the Boer War, and he resigned his post as Professor of Pathology at the Army College at Netley in protest. Conan Doyle had written of his support of this form of vaccination in the BMJ in July 1900.
Clinical Philosophy and Practice
To understand the physician it is not enough to merely look at his clinical knowledge. His bedside manner must also be considered: his clinical practice and philosophy, or the manner in which he perceives and handles his patients. An extension of this is his awareness of suffering in different groups of society and his attitude towards the population on health issues, such as the preventative role of smallpox vaccination.
A presentation speech Conan Doyle gave in 1900 at Saint Mary's Hospital, London, gives an insight into some of the views he held on clinical management. He reminded the graduates that when using the skills of diagnosis a doctor must not push aside humanity and kindness in the treatment of his patients. This philosophy is the theme of his medical tale 'Behind the Times' (1894), in which two new young doctors who practice with a cold 'up to date' scientific approach are, unknown to each other, both taken ill at the same time. However, they do not send for each other: both send for old Dr Winter, who they have, until now, considered an out of date practitioner. Unlike the two young doctors, however, Dr Winter has a bedside manner of humanity and kindness. Conan Doyle's story urges the maintaining of a humane and caring approach in the then rapidly changing scientific world of Victorian medicine.
Conan Doyle's medical short stories reflect his understanding and views of the medical world. He drew from his own training and practice to add realism to his fictional medical world. One example of this is in the story 'The Third Generation' (1894), which discusses syphilis. The disease knew no boundaries in Victorian England, and was a major health problem with antipathetic moral and social attitudes surrounding it. In the tale Sir Francis Norton develops the symptoms of syphilis, in his case congenital. The disease is not named, only inferred from the description of skin ulcerations, interstitial keratitis, and abnormal teeth. These would have been. Hutchinson's incisors (barrel shaped incisors with distinctively crescentic incisal edges), and moon molars.
The doctor's examination, and Sir Francis' medical history, reveal that the syphilis has been inherited from the grandfather, as Sir Francis' father had also developed similar symptoms late in life. When Sir Francis learns (or perhaps receives confirmation) of his condition he commits suicide before his forthcoming marriage; but not before asking how this could have happened to him and declaring that it was not his fault, as he was born blameless of guilt.
This self-questioning, as well as the description of the grandfather's lifestyle of womanising and drinking, was used as a public health and moral warning to readers. Conan Doyle had written to the press about the problems of prostitution, the spread of syphilis, and its effect on future generations. He felt that this was a health issue that had to be tackled, not pushed under the table for fear of offending moral delicacy.
Conan Doyle also drew on his medical experiences to add realism to his fictional doctors and patients. He tackled the financial and business side of medicine, by showing how it affected a doctor's practice and the pressures it placed upon him. In 'The Curse of Eve' (1894), he justified Doctor Pritchard informing the patient of his fee before attending the consultation, by describing the doctor's need to support his family and his hours of committed work. In 'The Resident Patient' (1893), Doctor Percy Trevelyan, who was awarded the Bruce Pinkerton Prize for his research into catalepsy, faced the hurdle of lack of capital which had to be overcome before he could start a specialist practice. Medicine, even for the successful academic, was a business, and had to be financed as such.
One of the best 'medical touches' which Conan Doyle adds to his doctor characters is found in Dr Mortimer in The Hound of the Baskervilles. At their first meeting, Holmes refers directly to Mortimer as 'Doctor. Mister, sir, Mister,' replies Mortimer, 'a humble M.R.C.S." Conan Doyle thus deftly raises the then current issue of whether all physicians (eg. M.B., F.R.C.P., L.R.C.P. holders) should have, and be referred to by, the courtesy title of doctor.
Conan Doyle's descriptions of some of his doctors' thoughts and reactions are not always the expected ones, but they add realism to the characters and therefore to the clinical settings. One example is the inner pleasure Dr Selby feels at diagnosing Sir Francis' unusual condition in 'The Third Generation': he almost forgets the consequences of the illness upon his patient. Another example is the reaction of Dr Miles in 'The Curse of Eve' when he receives Mr Johnson's urgent plea to attend his wife, who is about to give birth for the first time. Unlike the husband, Dr Miles does not view this as an urgent case: to him it is a routine, everyday request. For the doctor, the more pressing matter is his next meal: as he informs Mr Johnson. 'You can't get an engine to run without coal.' A doctor must keep himself healthy.
In 'His First Operation' (1894) an atmosphere of realism is created by the description of the operating theatre lined with 'tiers of horse-shoe benches, rising from the floor to the ceiling. The benches are packed with students, and visiting doctors and surgeons such as Peterson, the skin grafting man, and Anthony Browne, who had removed a larynx successfully the winter before. The surgeon Archer is described as 'one of the carbolic acid men', which recalls the debate that raged between 1867 and 1871. It centred on Lister's theories and practices of antiseptic principles: he had stated that micro-organisms were the cause of post-operative sepsis, and could be prevented by the use of carbolic acid spray at surgery. Carbolic acid mania was opposed by many surgeons who still believed that cleaning with cold water was sufficient. A further touch of realism is added by the naming of the instruments laid out on a table awaiting the surgeon: forceps, tenacula, saws, cannulas, and trocars.
Before entering the theatre, the students meet the out-patient clerk and ask him if there has been 'anything good', meaning recent patients. The clerk reels off a clinical list in reply: 'A popliteal aneurism, a Colle's fracture, a spina bifida, a tropical abcess and an elephantiasis. The surgery case the students are about to witness is a parotid tumour, 'originally cartilaginous but now assuming malignant characteristics' and extending right away behind the carotids. The proposed surgery is outlined: 'a free incision over the posterior border and... another forward at right angles to the lower end of it.'
Conan Doyle also injects humour: when the third year student is asked who is standing by the operating table, he replies. 'Nobody — dressers'. This is a medical student in-joke: the dressers he speaks of so dismissively are fellow students.
I have dwelt on 'His First Operation', as I think it is one of Conan Doyle's best medical tales: the other one being 'Behind the Times. In the tale he draws vividly and extensively from the medical world and his own student days. Could this entertaining and detailed tale of medical students have been written by a non-doctor at that time? I doubt it.
Reassessment of Doctor Conan Doyle
Rodin and Key, in their extensively and excellently researched book Medical Casebook of Doctor Arthur Conan Doyle, assess Conan Doyle as an 'exceptional medical personage, and state that he had the potential to be a 'great' doctor. This assessment is, I feel, unwarranted praise; but I do not support the continued myth that he was a failure as a doctor. The evidence, when examined in relation to his practitioner peers, points to Conan Doyle's achievements as no more or no less than an average general practitioner.
Rodin and Key place high emphasis on Conan Doyle's attainment of an M.D., and his strong opposition to the anti-vaccinationists. At this period a large number of practitioners attained M.D.'s, and Conan Doyle's doctoral thesis was not a significant step in the advancement of treatment of tabes dorsalis. There were also many practitioners and medical officers who opposed the anti-vaccinationists and the repealing of the Contagious Diseases Acts. To Conan Doyle's credit, however, he comes across as a competent and humane practitioner. In A Study in Southsea, Geoffrey Stavert says, 'that his income did not rise above £300 was not due to any incompetence on his part but simply due to the amount of competition.' I would add to this that when one considers the class of patients he was treating, and takes into account the fact that he could only work a certain number of hours a day, one must conclude that he had probably reached the maximum income level achievable.
In the future I believe that the myths about Conan Doyle as a medical failure will be laid to rest, and that following reassessment he will become accepted and remembered as a competent and humane Victorian general practitioner. I hope, however, that this reassessment will not swing from undervaluing his medical. achievements and skills to pushing him to the forefront of Victorian medicine in terms of practitioner skills, philosophy, and scientific research. This would not be justice, as the truth lies somewhere in between. Conan Doyle should be remembered as an averagely successful seaside town general practitioner, who realised that he had made the wrong professional decision in becoming a specialist. Fortunately, however, he made no such error regarding his literary career.
References
1. Green, R. L. and Gibson, J. M. (eds.): Letters to the Press; Secker and Warburg, 1986, p. 13.
2. Ibid., p. 18.
3. Ibid., p. 27.
4. Ibid., p. 15.
5. Ibid., p. 35.
6. Dubois, Rene and Jean: The White Plague: 1987.
7. Pound, Reginald: Harley Street, 1967.
8. Crouch, J. D.: 'Dr. Conan Doyle in Bloemfontein, Part II'; ACD; Vol. 2, No. 1. pp. 37-38.
- Article courtesy Christopher Roden, founder of The Arthur Conan Doyle Society (1989-2003).
