Part 8

Large mammals are referred to more often. Dr. Watson writes, in _A Study in Scarlet_, “The coyote skulks among the scrub ... and the grizzly bear lumbers along the dark ravines....” Big-horn sheep also appear: “... there stood a creature somewhat resembling a sheep in appearance, but armed with a pair of gigantic horns. The big-horn--for so it was called....” In this same story, bison are also to be found. Holmes, exasperated when looking for footprints, says, “If a herd of buffaloes happened along, there could not be a greater mess.” In still another instance, Watson writes, “... the observer would have come to the conclusion that one of those great herds of bisons which graze upon the prairie land was approaching him.” A herd of bison is referred to again in _The Boscombe Valley Mystery_. Holmes feelingly remarks, “Oh, how simple it would all have been had I been there before they came like a herd of buffalo and wallowed over it!” It is obvious that Holmes was impressed with the immense herds of buffalo which once roamed over the great plains of our romantic West.

In _The Valley of Fear_, we come across an interesting analogy. Holmes remarks to Watson that Porlock, although unimportant in his own right, nevertheless takes on importance through his close touch with the master criminal Professor Moriarty. He spoke of the relationship of the two men as that of the pilot fish to the shark, or of the jackal to the lion; that is, one was insignificant and the other formidable. In this same story, our attention is called to two other mammals--the wolf and the caribou. In _The Adventure of the Speckled Band_, we are introduced to two African animals, the cheetah (reputed to be the fastest animal on earth) and the baboon. And in _The Adventure of the Creeping Man_, reference is made to one of the higher apes, the langur, which is described as a large animal with a black face living on the slopes of the Himalayas.

When we read about large mammals, big-game hunting comes to mind, at least to the sportsman. Several allusions to this exciting and dangerous sport are found in the tales. In _The Naval Treaty_, we read, “... it has the sort of excitement about it that the sportsman feels when he lies beside the water course and waits for the big game.” In _The Adventure of Black Peter_, we read again of the hunter’s thrill while lying in wait for some unknown large beast to approach the water hole.

When Sherlock Holmes ironically introduces the terrible Colonel Moran to Dr. Watson and Lestrade, he says, among other things, that the Colonel is an outstanding big-game hunter, practically without peer, and that his bag of tigers remains unrivaled (_The Adventure of the Empty House_). In _The Adventure of the Bruce-Partington Plans_, Holmes notes that it was such a foggy day in London that a thief or murderer could roam the streets and pounce on his prey like a tiger in the jungle. In another instance, Holmes tells Watson about Count Sylvius, the famous big-game hunter who had stolen the Crown diamond. The nonchalant detective facetiously remarks that if the Count could add him (Holmes) to his bag of big game, it would be an outstanding triumph (_The Adventure of the Mazarin Stone_).

The numerous allusions to animal life in the tales show clearly that Dr. Watson was keenly interested in zoology. This is not unexpected, since he was a physician, and, as everyone knows, a student of medicine has a broad training in the biological sciences. It is doubtful whether a man untrained in biologic science could have used the references to animals as accurately and as effectively as did Dr. Watson.

Where did he obtain his love for zoology? Solely from his preparatory studies in medicine? Probably not. Dr. Watson was an athlete and an outdoor man. Such men frequently take a pronounced interest in plant and animal life, since it is before their eyes a good part of the time.

We may conclude, then, that Dr. Watson was not only a physician, an amateur detective, an athlete, and a man of letters, but a zoologist as well. In this age of specialization, it is refreshing to reflect that Dr. Watson had such a wide range of interests.

DOCTOR WATSON, CARDIOLOGIST

“Marsten had sprung out of his chair in a paroxysm of anger, when he suddenly pressed his hand to his side, his face turned a dusky hue, and he fell backward....”

_The Sign of the Four_

Dr. Watson did not profess to be a cardiologist, but rather a general practitioner of medicine. There are more allusions to minor surgery and to nervous disorders in the tales than there are to diseases of the heart or circulation. There are, however, several references to the latter which are of historical interest to medical students and practicing physicians.

Let us examine some of the references to cardiovascular conditions. In _The Sign of the Four_, a sudden cardiac death already cited above is described:

Marsten had sprung out of his chair in a paroxysm of anger, when he suddenly pressed his hand to his side, his face turned a dusky hue, and he fell backward, cutting his head against the corner of the treasure-chest. When I stooped over him, I found to my horror that he was dead.

The cause of death in this instance, so dramatically described, presumably was produced by a coronary occlusion. It is noteworthy that the patient was “in a paroxysm of anger” at the time he was stricken. One is reminded of John Hunter, the famous English anatomist, who in later life suffered from severe angina pectoris. He is reputed to have said that he was at the mercy of any rascal who saw fit to make him angry. Any intense emotion, of course, is capable of producing profound effects on the cardiovascular system.

It will be remembered in the novel, _The Hound of the Baskervilles_, that Sir Charles Baskerville had a cardiac disorder. His friend and physician, Dr. James Mortimer, had concurred that “Sir Charles’ health has for some time been impaired, and points especially to some affection of the heart manifesting itself in changes in colour, breathlessness, and acute attacks of nervous depression.” One evening, when Sir Charles was taking his customary walk between the rows of yew trees, he saw the awesome hound; he became greatly frightened and ran as fast as he could toward Baskerville Hall. He fell dead before he reached the house. In this instance, the intense mental excitement and the tremendous physical effort caused heart failure--perhaps ventricular failure produced by a diseased myocardium rather than a coronary occlusion.

Physical exertion does not necessarily produce a coronary occlusion. It was once thought that patients suffering from angina pectoris, or who actually had coronary disease, should not exert themselves physically. They were warned, for example, not to run to catch a streetcar. A more liberal view is held today; most patients are urged to exercise themselves. In point of fact, many coronary occlusions occur when the patient is at complete rest or performing some slight task.

An interesting allusion to cardiac neurosis may be found in _The Sign of the Four_. When Dr. Watson was introduced to Thaddeus Sholto, the latter became greatly excited and said: “A doctor, eh?... Have you your stethoscope? Might I ask you--would you have the kindness? I have grave doubts as to my mitral valve, if you would be so very good. The aortic I may rely upon, but I would value your opinion upon the mitral.” After Dr. Watson had listened to Sholto’s heart, and had assured him that he had no cause for uneasiness, the patient turned to Miss Morstan and said: “You will excuse my anxiety, Miss Morstan ... I am a great sufferer, and I have long had suspicions as to that valve. I am delighted to hear that they are unwarranted.”

The above clearly depicts a man who is unduly, and probably needlessly, alarmed about the condition of his heart; the diagnosis of cardiac neurosis can obviously be made. This could have been brought about by some physician who, in an ill-advised moment, had hinted to the patient that he might be suffering from a cardiac disorder. Such a condition is spoken of as “iatrogenic heart disease.” Unfortunately, a good many people suffer from cardioneurosis, and the majority probably would be benefited by consulting a psychiatrist. The doctor might be able to ascertain the underlying cause for the patient’s fear.

These passages from _The Sign of the Four_ show that Dr. Watson was acquainted with valvular heart disease; they are, however, rather farfetched, if not ludicrous, and probably could not be appreciated by the nonmedical reader. Watson does not often attempt to show his erudition or weary his readers by employing technical terms. A good example of this matter-of-factness may be found in _The Crooked Man_: “The injury from which this 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 above is written in a language that anyone can understand.

In the novel _A Study in Scarlet_, may be found an interesting reference to an aortic aneurism. Jefferson Hope told Dr. Watson to put his hand over his heart. Watson writes:

I did so, and became at once conscious of an extraordinary throbbing and commotion which was going on inside. The walls of the chest seemed to thrill and quiver as a frail building would do inside when some powerful engine was at work. In the silence of the room I could hear a dull humming and buzzing noise which proceeded from the same source.

Dr. Watson promptly diagnosed it as an aortic aneurism. Just before Watson made his examination, Jefferson Hope had put up a terrific struggle to escape capture, and it had taken four men to subdue him:

So powerful and fierce was he that the four of us were shaken off again and again. He appeared to have the convulsive strength of a man in an epileptic fit. It was not until Lestrade succeeded in getting his hand inside his neckcloth and half strangling him that we made him realize that his struggles were of no avail.

The remarkable thing is that this man was suffering from an aortic aneurism which was on the point of bursting. Why the aneurism did not burst during the terrific struggle will always be a mystery. We find later in the story that it subsequently did burst.

Several references to the pulse may be found in the tales. When the pompous if dignified Thorney Huxtable, M.A., Ph.D., collapsed in Holmes’ living room, Dr. Watson attended him, and described the condition as one of severe exhaustion; he spoke of the pulse as being thready in character (_The Adventure of the Priory School_). In _The Adventure of the Stock Broker’s Clerk_, a man had tried to hang himself, but Dr. Watson helped rescue him just in time. The patient was placed on the floor, and the good doctor immediately felt his pulse; he reported that it was feeble and intermittent.

At the time Dr. Watson practiced medicine, more attention was probably paid to the study of the pulse than now obtains. The experienced physician knows that considerable information can be obtained by studying the pulse. Not only can the rate be ascertained, but the character of the beat as well: whether it is full or bounding, or thready or feeble, and the like. By digital pressure on the radial artery, a rough idea can be obtained of the systemic blood pressure, and at the same time some information can be gained as to whether the artery shows any sclerosis.

Some physicians of the older school feel that the younger generation of physicians neglects the pulse, and its study is becoming a lost art. The more recently trained physicians are more apt to depend upon certain instruments of precision. Be that as it may, we have already seen that Dr. Watson attempted to gain as much information as he could by feeling the pulse.

On one occasion (_The Adventure of Shoscombe Old Place_), Dr. Watson speaks of a failing heart; he describes a patient who had a dropsical condition. When reading about a failing heart in English medical literature, one cannot but think of William Withering (1741-99), who was the first physician to employ digitalis therapeutically as a single pharmacologic agent. He reported his findings many years before Dr. Watson practiced medicine. It is singular that Dr. Watson never mentioned any digitalis preparation in the Sherlock Holmes stories. He does mention amyl nitrite, but not in connection with any heart condition; he also mentions morphine as a drug to assuage pain, but again not in connection with the heart.

Since the time Dr. Watson practiced medicine in London, great strides have been made in the diagnosis and treatment of cardiovascular disorders. The electrocardiogram and other instruments have been developed for diagnosing disorders of the heart and vessels. Methods of treatment, such as the use of antibiotic drugs, and agents for reducing high blood pressure, have been of inestimable value.

In this country during the past few years, the citizens have become increasingly aware of the value of research in cardiovascular disease. It is noteworthy that a part of this interest was stimulated by the fact that President Dwight D. Eisenhower suffered a coronary occlusion and later a mild cerebral accident.

In conclusion, when Dr. Watson practiced medicine, he did not have any effective drugs at his disposal to combat hypertension, or any drugs, such as dicumarol, to lessen the danger of further coronary occlusions. We may be assured, however, that those agents he did have were used to the best of his ability, and he did all he could to restore the patient to health. No man could do more.

THE PHYSIOLOGIC DOCTOR WATSON

“Surely your medical experience will tell you, Watson, that weakness in one limb is often compensated for by exceptional strength in the other.”

_The Man with the Twisted Lip_

Since I am a professional physiologist, references made to physiologic matters in the tales are of especial interest to me. Physiology, as the term is now used, may be defined as the science which deals with the function of an organism and its parts, in contrast with anatomy, which is concerned only with the structure of an organism.

Dr. Watson took his work at the University of London Medical School, and was graduated in 1878--eighty years ago. We may assume that he received good training in physiology; at any rate, he apparently had a healthy respect for this important science. Let us examine the references he makes to physiologic matters in the tales.

_Physiologists_

In _The Adventure of the Creeping Man_, a physiologist, Professor Presbury, is the central figure. Dr. Watson speaks of him as a renowned “Camford” physiologist. The word “Camford” is a happy choice. It strikes one that it could be a combination of two words, Cambridge and Oxford. Whether Dr. Watson had these two famous schools in mind, I cannot say, but I am inclined to believe he did. It is noteworthy that he depicts Professor Presbury as a wealthy man. On one occasion, Sherlock Holmes and Doctor Watson called at Presbury’s home. The good doctor wrote glowingly about the physiologist’s charming house and beautiful grounds, and emphasized that the professor was surrounded with every sign of luxury.

This is truly an unusual picture, for not many professional physiologists are wealthy, and they certainly are not surrounded with luxury. Professor Presbury, fortunately, was an exception. He must have been a wealthy man in his own right, or have married a woman of means, for surely he did not become wealthy by teaching physiology.

Professor Presbury’s assistant, Mr. Trevor Bennett, is interestingly pictured as a handsome, tall young man, and elegantly dressed. He was portrayed as having the shyness of the student rather than the self-possession of a man of the world. We can readily understand his shyness and his studious manner, but it is more difficult to imagine his elegant appearance. Bennett, we find later, had a medical degree, so perhaps he enjoyed a consulting clinical practice, which might account for his exceptional elegance.

Mr. Bennett’s careful grooming is in contrast to the usual situation, because physiologists, I fear, do not have the reputation for being well-dressed people. They are apt to be somewhat indifferent about their personal appearance, especially when at work in the laboratory. This is quite understandable, since they often work with such animals as cats, dogs, and monkeys, and with even larger animals like sheep, goats, and pigs. Some of the more fastidious scientists don old clothes for such occasions, but this is not always convenient. At any rate, the average physiologist is not known for his elegant appearance--and for good measure, I will throw in the pharmacologists also! Several living examples of each could be cited to prove my point, but I must refrain from embarrassing my distinguished friends and colleagues. At least Mr. Bennett may be considered an exception.

_Endocrinology_

In the story discussed above, the author uses the theme of endocrinology. Professor Presbury, widower in his early sixties, had fallen madly in love with a very young girl. In his desire to regain his lost youth, the professor administered to himself injections of serum prepared from apes. A conniving Prague scientist had prepared the material from the langur, which Watson dramatically described as one of the higher apes, distinguished by a black face, and an inhabitant of the slopes of the Himalayas.

According to the story, the serum had a profound effect on the professor. Following the serum injections, which he took at nine-day intervals, he acquired the characteristics of an ape, not only by simulating the mode of locomotion of this animal but by developing, also, an uncanny ability to climb.

One night, following a serum injection, the professor got into grave difficulty when his heretofore faithful wolfhound Roy, which he was bedeviling, attacked him viciously. As Sherlock Holmes told Dr. Watson, the wolfhound thought he was attacking the monkey, not his master. Presbury was saved by the quick action of Holmes and Watson.

The plot is fantastic, but interestingly told. Today this story would be regarded as science-fiction. It was written at a time when the subject of rejuvenescence had been made popular by the endocrine studies of Steinach and of Voronoff, the European scientists. The father of endocrinological studies was, of course, Charles-Edouard Brown-Séquard, who had reported his studies on testicular extracts in 1889. Dr. Watson was undoubtedly familiar with Brown-Séquard’s work. In _The Adventure of the Creeping Man_, Holmes points out a moral when he remarks to Watson that, if one leaves the straight road to destiny, even the highest type man may revert to the animal.

_Digestion_

Let us turn to the physiology of digestion. Dr. Watson obviously felt that one should eat sparingly if brain work is to be done. We find him saying that his friend Holmes had eaten no breakfast, because in his more intense moments he allowed himself no food. Holmes contended that he did not have energy to spare for both nerve force and digestion (_The Adventure of the Norwood Builder_). On another occasion, Holmes, when talking to Doctor Watson, emphasized the fact that starvation refines the faculties. He insisted that during digestion the brain is robbed of blood, because blood is needed in the splanchnic area. Holmes insisted that he himself was a brain, and the rest of his body a mere appendix (_The Adventure of the Mazarin Stone_).

The ideas expressed in the above paragraph hold our physiologic interest because, at the time Watson wrote, the concept he expressed was the accepted one. Later work has shown that this theory is not tenable. The modern view is that digestion does not influence the blood supply to the brain. In point of fact, nature has taken careful precautions to ensure the brain of a rich blood supply at all times under normal physiologic conditions.

Although the brain does not suffer in its blood supply during digestion, it is well known that the body is capable of shunting blood to those regions which are functioning and are, therefore, in need of it. If a hearty meal is eaten, a rich supply of blood is required to digest and absorb it. Athletes know that a large meal should not be eaten before taking strenuous exercise. Indeed, if a substantial amount of food be eaten preceding intense physical exertion, the athlete may become nauseated or even vomit.

The voluntary muscles need blood when functioning, and the greater the amount of exercise, the more blood is needed. The circulatory system cannot supply both the splanchnic region and the skeletal muscles under these conditions, so some part of the body must suffer. The nausea and vomiting are, in a measure at least, produced by anemia of the stomach. In the example just given, there is also a nervous component, which in some individuals plays an extremely important part.

Let us return to the blood supply of the brain. There is some evidence that the brain needs a slightly increased blood supply during lively mental activity, but not all physiologists will accept these findings. However, this may safely be stated: the metabolism of the brain is high at all times and is not affected by mental work. If one indulges in “heavy thinking,” one simply directs the activities of the nerve cells in the brain, which already are active.

If we accept the hypothesis that increased mental activity does call for slightly more blood to the brain, then the mind actually may be more keen and alert when the circulatory system does not have to sustain the burden of digestion and absorption of food. The fact that there is often a feeling of well-being following a satisfying meal does not negate this concept. There are those who maintain that the mind functions best during a state of moderate fasting. Dr. Watson evidently believed this, as has been previously stated. All physiologists would not agree with this concept. Undoubtedly, there is a wide individual variation in this regard, and it would be unwise to make a sweeping generalization.

_A Weaker Sex?_

Dr. Watson implies, in _The Adventure of the Devil’s Foot_, that physiologically the female has a weaker constitution than the male. In this story, it will be recalled that two men and one woman were exposed to the fumes of the powdered devil’s-foot root. Watson stated that only the woman was killed, presumably because she was the more sensitive. This is indeed a challenging statement.

Considerable proof can be adduced to show that the female is hardier than the male. The old cliché, “the weaker sex,” can be seriously questioned. It is well known, for example, that women can withstand a high blood pressure for years. In some instances, although by no means all, it seems to do them but little harm, since in spite of it they may live to a ripe old age. Hypertension in the male is generally a serious condition. Many men die comparatively young from heart failure or from cerebral hemorrhage due to hypertensive states.

Recently, it has been shown that female animals, such as rats, can withstand acute oxygen-want far better than males. I do not wish to belabor the point that the female may be hardier than the male, but two more bits of evidence can be presented. Data compiled by life-insurance companies definitely show that there are more widows in this country than widowers. Lastly, more boy babies die than girl babies.