Museum of Health Care Blog

In a special October iteration of Ex Crypta, I wrote a piece exploring the history of blood transfusion through the lens of the classic gothic novel Dracula. As well as being well-received and a delight to research, marrying literature and medicine together offered an interesting way to ground medical history in something more familiar.

As I scouted around for something to write about this time, I decided to go back to that literary well. And who better than Sherlock Holmes? Sherlock’s author, Arthur Conan Doyle, was a general practitioner. Holmes himself was based on a surgeon, Joseph Bell. And his famous companion, John Watson, is a doctor, although he practiced only intermittently.

Nor did the connection stop with a few titles. A survey showed that, among other medical references, the Holmes stories mention 68 different diseases – not bad, considering there are only 60 Holmes stories in total. Holmes, then, seemed the perfect guide for a quick and slightly madcap tour of the Museum of Health Care’s collections.

(I know that the canon of Holmes is somewhat inconsistent – I have chosen to take his 1887 introductory story, A Study in Scarlet, as the basis of this piece).

Though I have called this a foray into the medical world of Sherlock Holmes, it is really Watson, as always, who will be our facilitator. Watson is the doctor, after all, and it is through Watson that medicine is often discussed. In fact, Watson himself begins as not just doctor but patient. He is introduced having just gotten over a bout of enteric fever sometime in the early to mid-1880s. In other words, typhoid or paratyphoid, which Watson refers to as “that curse of our Indian possessions.” It is, unfortunately, still an issue in the now independent India, although rates have been declining in recent years (nor, in his grumbling, does Watson seem to recognize his own empire’s role in the disease’s prevalence).

Typhoid is now treated with antibiotics and can even be vaccinated against. For Watson, though, such treatments would be years away. Though there had previously been work done in the field, penicillin wouldn’t be purified and released until 1939 and the antibiotics age wouldn’t kick into gear until the mid-1900s. The word antibiotic wouldn’t even be used as a noun describing this particular medical treatment until 1941.

Watson doesn’t mention how he was treated for his fever, only that it took months and weakened him considerably. In a place where typhoid fever was prevalent, it is unlikely that he was getting the most up-to-date treatment. Bed rest seems to have been a common suggestion for any ailment. This was also the era of patent medicines, so Watson may have been fed or availed himself of a whole range of tonics of varying degrees of effectiveness. However, given his later professed dislike of Holmes’ cocaine use, we can assume he didn’t touch opioids during his recovery.

This item from our collection dates from the 1800s and promises to cure, among other maladies, pneumonia, tuberculosis, and typhoid. Though not mentioned, perhaps Watson would have taken this or a similar medicine. Lactalbumin, Museum of Health Care 1980.18.310

Though he was very ill, Watson was lucky. About a fifth of typhoid patients ended up with a gastrointestinal hemorrhage. Unluckier still, intestinal perforation could also sometimes result, a common cause of mortality. By the late 1800s, this was sometimes treated through surgery. Watson doesn’t mention going under the knife but had he needed to, he could have. Anaesthetics were in common use by that point; Watson might have been dosed with ether (first administered in Britain in 1846), chloroform (anesthetic properties discovered in 1847) or even perhaps nitrous oxide (discovered in the 1700s, first used in London in 1868, often used in conjunction with ether).

An ether drop bottle, circa 1870 – 1930. Perhaps a familiar sight for Watson. Esmarch’s ether drop bottle, Museum of Health Care 1979.7.

Furthermore, Watson could at least comfort himself that he knew exactly what was making him sick. Not only had germ theory been established by that point, Salmonella typhi itself was identified in 1880.

Having more or less recovered, Watson returns to England, moves in with Sherlock Holmes, and begins chronicling their adventures together. Although too ill to practice in this first story, Watson’s medical knowledge comes into play several times.

His first instance of flexing his training and experience occurs as he catalogues what Holmes knows and does not, commenting of botany that Holmes is “well up in belladonna, opium, and poisons generally.” So, too, presumably, was Watson; botany was taught in medical schools until the end of the 19^th century. It is interesting that he categorizes both belladonna and opium as poisons, considering he may have previously kept both in his medical bag.

Opium itself has been used as a painkiller for millennia and its derivatives were common throughout the 1800s. Morphine was isolated early in the century and commercially available in London in 1821. Its use by doctors became even more widespread after the invention of the modern hypodermic syringe in 1853.

Watson, perhaps because he was young and freshly trained, was a forward-thinking doctor. He appears largely dismissive of narcotics. Meanwhile, many of his older colleagues would have spent much of their careers relying on morphine as a dependable cure-all and many opium derivatives were available in shops without a prescription. It was only in the end of the 19^th century that doctors began to raise concerns about the dangers of opiates. 

Mrs. Winslow’s Soothing Syrup, an over-the-counter medicine given to children and from which morphine was only removed in 1906. Museum of Health Care
1977.12.165

Belladonna, meanwhile, had a number of medicinal uses in the latter part of the 19^th century. It was used in the treatment of eye diseases, asthma, whooping cough, and constipation, among others. Observed Hyde Salter in 1869, “I do not know any sedative that has more “improved its position” of late years than belladonna.” (p. 152).

It was also used in plasters, although a doctor in 1887 would have understood the risks of this method. Cases of poisoning by belladonna plaster had been reported more than a decade ago, with several doctors observing wryly that they’d at first mistaken the symptoms for scarlet fever due to the rash and general malaise.  

Little wonder then, after all, that Watson viewed both plants with polite distrust.

As Watson and Holmes engage in their first case together, Holmes himself calls upon Watson’s medical expertise in identifying the murder weapon.

“Give them here,” said Holmes. “Now, Doctor,” turning to me, “are those ordinary pills?”

They certainly were not. They were of a pearly grey colour, small, round, and almost transparent against the light. “From their lightness and transparency, I should imagine that they are soluble in water,” I remarked.

While Watson certainly understood about prescription, he was unlikely to have made his own medication. Apothecaries had been common for centuries and were even able to prescribe their own medicines after 1704 (although they could charge only for the medicine, not for the diagnosis or advice). The Apothecaries’ Act of 1815 gave the Society of Apothecaries in London the right to certify apothecaries as general practitioners, as well as examine dispensers (including, in 1917, the Queen of Crime herself, Agatha Christie). Druggists were also well-established by then, having risen in the later 18^th century as sellers and manufacturers of drugs. However, concerns about adulteration of medication were still ongoing; possibly the reason that Watson had familiarized himself enough with pills to be confident in being able to assert whether one is “ordinary.”

Watson’s medical knowledge is called in to play one last time at the conclusion of A Study in Scarlet. The book begins with Watson suffering from a nearly terminal disease. It ends with him diagnosing one:

“Then put your hand here,” he said, with a smile, motioning with his manacled wrists towards his chest.

I did so; and became at once conscious of an extraordinary throbbing and commotion which was going on inside. The walls of his 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.

Why,” I cried, “you have an aortic aneurism!”

Watson was hardly ahead of his time in his diagnosis; I’ve found a reference to an aortic aneurysm from 1727. Though Watson does not mention the chest swelling common with a bulge in the aorta, he does mention a sound. He uses neither the term murmur nor bruit, key diagnostic features even today, but then, he also apparently didn’t pull out a stethoscope; instead he seemed to have been relying on the old method of simply putting his ear near the patient’s chest. The monaural stethoscope had been invented in 1816 and a functional binaural form was developed in the 1850s, although apparently unpopular in England until around the time when Watson started practicing.

At only 13cm (~5″) long, this monaural stethoscope from circa 1860 – 1890 would have been fairly easy to carry around. Museum of Health Care 997002010

We will allow him grace in not further investigating the illness, as he was diagnosing a confessed murderer about to be arrested and possibly hanged, and so could not really be expected to concern himself with providing medical aid. Not that Watson might have helped much, even if he cared to. Contemporary writings offered bed rest and potassium iodide and little else as treatments. Watson likely would have been astonished by modern surgical techniques and medications; beta-blockers, for example, are now used to treat aneurysms and were first synthesized in the 1960s.

Watson may have been a great chronicler, but he was no great general practitioner. His experience, then, is that of the ordinary doctor. The more one sees the world Watson would have navigated as a medic, the more one appreciates the extraordinary position he was in: at the tail end of one century of medical innovation, on the cusp of another. And I rather find myself hoping that Watson at least sometimes had the chance to marvel at his own profession with the same awe as he did his companion’s.