Arthur Conan Doyle and the romance of medicine

Michael D. Shulman
Philadelphia, Pennsylvania, USA

  Sir Arthur Conan Doyle 

For medical professionals devoted to good literature, Dr. (later Sir) Arthur Conan Doyle is a source of possessive pride. He is someone like them, a physician with the interests of a polymath and the creative sensibility of an artist. And yet this cannot be a complete account because at the age of thirty-two, after only nine years in practice, Conan Doyle turned his back forever on his medical career. It was an act of abdication that has prompted many attempts to explain why it was not also an act of betrayal, attempts centering mostly on the tribulations of his penurious practice that compelled him to seek his livelihood elsewhere.

The fragile claims of the medical fraternity on Conan Doyle can be contrasted with the more congenial example of Dr. William Carlos Williams. Williams, throughout a lengthy career, succeeded in maintaining a busy suburban practice as a general practitioner and pediatrician in Rutherford, New Jersey, while famously introducing colloquial American English to the epic poem. It is an appealing image – this semblance of the creative artist rummaging for ideas for poems while making house calls, contriving thus to serve both Apollo and Asclepius. Williams, it could be hoped, attested to the creative genius latent in every physician, and reciprocally, to the healing properties of well-crafted verse, giving hope to those in both camps. The twin careers of Conan Doyle, however, were not like that, and claims of his devotion to medicine, usually emanating from physicians, have a distinctly defensive tone. When one learns more about the man, it becomes clear why such a defense is necessary.

Conan Doyle’s professional life did not seamlessly fuse two parallel careers in the manner of Dr. Williams. Instead, it unfolded in two sharply divided phases. After graduating from Edinburgh University with the degree of Bachelor of Medicine in 1881 (the MD was then an advanced degree which he would earn by writing a thesis four years later), Conan Doyle took a faltering stab at general medical practice, followed by a disastrous attempt to establish himself, in London, as a specialist in eye surgery. Of the latter effort, fashionable London took no notice. His waiting room on Harley Street was poshly appointed, in a neighborhood home to some of the most famous physicians in the world, but Conan Doyle quickly discovered that he was the only person waiting in it.

Now facing an abyss of poverty and professional isolation (the familiar story goes), and lacking social connections or private income, Conan Doyle seized on an untested resource. He turned to writing, brokering a nascent talent into a brilliant and lucrative career, never neglecting to incorporate elements of medicine into his fictional work. And yet, in the canonical account of his life, the literary lion remained at heart a medical man. Who was Sherlock Holmes, after all, but a doctor with surpassing powers of deduction who chose to specialize in the diagnosis of crime? What better model for the clue-seeking clinical investigation than high-powered sleuthing? It is a reassuring account not least because it repudiates the idea that Conan Doyle abandoned the medical profession with anything but deep regret. As one physician author put it, in a laudatory treatment of Conan Doyle’s medical roots, “Once a doctor, always a doctor.”1

To be sure, this version of Doyle’s departure from medicine – the practice that inexplicably failed, the reluctant professional volte face, the admiring recapitulation of the medical mind in the character of Sherlock Holmes – is easily embraced, but it is also a heavily biased version of actual events. When Conan Doyle addressed a group of medical students in 1910, it was with a tone of friendly rebuke, reminding them that the “the romance of medicine” requires a spirit not bogged down by undue materialism and “intellectual priggishness.”2 “Empirical knowledge,” he stressed, is not everything. This suspicion of empiricism is an unsubtle clue that Conan Doyle’s medical practice had not wilted on the vine. It had in fact been resolutely plucked in the bud. And as genuine as was his regard for medicine – a field to which he always acknowledged his intellectual debt – its discipline was alien to a vital piece of his genius and temperament. Dr. Watson, in his steadfastness, his solid good sense, and his companionability, is drawn indisputably to honor a debt to medicine. But Watson, it would do well to remember, was not Conan Doyle’s exemplar.

From the beginning, even as Conan Doyle contemplated the advantages of a medical career, there had been soft rumblings of resistance. The Doyle family had famously produced a succession of brilliant artists – his grandfather had been a prominent political cartoonist, and his paternal uncle had illustrated the works of Dickens and Thackeray. But pressed by his father’s alcoholism and indigence, Conan Doyle yielded to the family’s need for a reliable source of income and applied for a scholarship to medical school. The medical school at Edinburgh was within walking distance of his home, a further inducement, as it spared the family the cost of boarding him. In choosing his profession, Conan Doyle laid no claim to fulfilling a life’s ambition. “It had been determined that I should be a doctor”3 was his laconic comment on the matter.

Can one detect, in that comment, the sound of foot-dragging? For it was certainly the case that Conan Doyle proved to be a wayward student of medicine. His academic performance was undistinguished: “I was always one of the ruck,” he recalled, “neither lingering nor gaining.”4 Despite the pressing need for an income, his graduation from medical school was delayed a year while he served, for about £2 a month, as ship’s doctor aboard an arctic whaler. Still later, he suspended the inauguration of his medical practice while he sailed as ship’s surgeon aboard a cargo vessel bound for the Gold Coast.

Regarding conventional medical research – which in his own day could be credited with the invention of the electrocardiogram, the identification of blood types, and the discovery of vitamins – Conan Doyle was usually respectful, especially when addressing physicians, but in less guarded moments he was apt to be dismissive. “I had no great interest in the more recent developments of my own profession,” he wrote in his autobiography, “and a very strong belief that much of the so-called progress was illusory.”5 Tellingly, the harsh verdict is cast so that it descends – not on any particular scientific development – but on the illusory nature of material progress itself.

His own research endeavors reflected an impatience with the “long weary grind” of his compulsory subjects (as he called it) and a preference for more Byronic undertakings. In a letter sent in September 1879 to the British Medical Journal,6 written while he was still a third-year medical student, he reported on the toxicity of the plant alkaloid gelsemium, known to him because he had prescribed it for his own “neuralgia.” The experimental design was simple: to ingest the drug (which had been blamed for many deaths) in increasing doses for as long as possible and “to see how far one might go.”

A bit too far was the answer. After several days of gelsemium in increasing doses, he was incapacitated by depression, headache, and blurred vision. He soldiered on undeterred. Soon his sensorium became clouded and his pulse weakened. Toward the end, he was gripped by overwhelming lassitude. Only profuse diarrhea persuaded him at last that it was time to cut bait and publish. Notably, this was an era when the natural humanitarianism of the medical profession was not routinely applied on behalf of its self-immolating practitioners. Subscribers to the Journal appear to have found nothing extraordinary in Conan Doyle’s report that he had risked his life ingesting doses of gelsemium thought to be lethal many times over.

Despite this self-wrought flirtation with death, Conan Doyle went on to graduate from medical school at age twenty-two. He would live to be seventy-one but would spend less than a decade devoted to a career in medicine. They were unsettled and peripatetic years. After graduating medical school as a Bachelor of Medicine (he received his MD, an advanced degree in Great Britain, four years later, after defending a thesis on tabes dorsalis) he worked as an assistant to Dr. Hoare, in Birmingham, but left after two months. Next he joined Dr. Budd in Plymouth, an association that lasted only a month.

His longest stint was in Southsea, where he spent eight years in solo practice. Widely described as an impoverishing misadventure, his practice in fact enjoyed modest success and growth, although constrained by local competition and the difficulties of creating opportunities without a private income. Conan Doyle reported his revenue for the first year to be only £154, but this rose slowly to £8007 at a time when £370 has been estimated to represent the earnings of the typical London practitioner.8 His patients and his community were evidently devoted to him, and his social calendar was crowded with public meetings and private speaking engagements.

But private practice could not contain his restless spirit for long. After acquiring some experience performing refractions for myopic patients, he set out for Vienna where, with the aim of remaking himself as an ophthalmologist, he attended two months of lectures on eye surgery. Insufficiently grounded in German and easily distracted by the company of his young bride and by the social diversions of Vienna, he profited little from his brief academic immersion. Nonetheless, he clung to his plan to open a specialty practice. A bit grandly, he rented an office in London, two blocks from the world-renowned practitioners on upscale Harley Street (and providentially, two blocks from Baker Street, which he had not then visited). A few weeks later, he was awaiting his first patient when he fell ill with influenza. It seemed a sign from Providence that he had chosen the wrong path. When he recovered, only one month after launching his London office, he was still awaiting his first patient. He then abandoned his career in medicine forever.

Turning to a full-time career as a writer of popular fiction, Conan Doyle is said to have devised the Sherlock Holmes stories as a kind of homage to his years as a physician. The claim is based in part on Conan Doyle’s own testimony that the character and appearance of Holmes were modeled on a cherished medical professor, right down to his cloth cap (the deerstalker was an embellishment of Sidney Paget, an illustrator for the Strand Magazine).

One might also point to the regard for the scientific method that seems to motivate the detective stories that Conan Doyle now began to produce as rapidly as one every week. Fictional detectives before Sherlock Holmes (Edgar Allen Poe’s Dupin is an influential exception) solved crimes with the indispensable helping hand of authorial omniscience. Critical clues, deliberately suppressed, were pulled from thin air, issuing ex nihilo from the mouths of all-seeing sleuths in time for the denouement of the author’s concluding paragraphs. But as Conan Doyle understood, detective work in the real world more nearly resembled the dogged perseverance of medical diagnosis. The labors of physicians are methodical and slow, never straying far from a touchstone built upon observation, deduction, and empirical testing. Such, roughly speaking, was the method of Sherlock Holmes. But it is possible for the fictional detective to emulate the practice of medicine while deviating from its essential nature. The game of chess – to offer an analogy – is modeled on the strategies of war, but it is a model in which the sanguinary chaos of the battlefield has been antiseptically stripped away.

In much the same fashion, the idealized ratiocinative gifts of Sherlock Holmes belong to the world of medicine only by analogy. The fictional detective is empowered to operate with an assurance – never granted to the physician – that all mysteries will ultimately yield to the concentrated effort of the superior brain. More critically, Holmes even at his most savant can hardly be imagined butting up against the intractable ailments, the misfired predictions, the inexplicable manifestations of obscure diseases or the dissembling manifestations of common ones that are routinely encountered in general practice. Scratch the hyper-rational Holmesian world and you will discover a magical place where causes and effects are as discrete as the stimulus and response of a reflex arc. In this imaginary universe, facts are forbidden to be mutually contradictory, and reasoning yields – not a notecard scribbled over with the probabilities captured in a physician’s “differential diagnosis” – but a Mosean tablet of eternal certainties, worthy of the permanence of cut stone.

Again and again, the Sherlock Holmes stories call upon the same (unfailingly entertaining) device: a few trifling, minutely detailed observations – observations which naturally escape everyone but our protagonist – provoke a spate of deductions, breathtaking in their detail, presumption, and laser-like accuracy. But this use of the word “deduction” is not quite right. In strict philosophical terms, the Holmesian formula is not deductive, for that would imply the logical necessity of a syllogism. Properly speaking, the Holmesian formula is abductive.9 To the logician, abduction has the rough meaning of drawing the most reasonable inference. But applied to the Holmesian thought process, it would be nearer the truth to say it simply means jumping to conclusions. Consider, for example, the legerdemain Holmes works on a cast-off hat:

 [He] picked it up and gazed at it. . .[concluding] that the man was highly intellectual… fairly well-to-do…although fallen upon evil days. He had foresight, but has less now than formerly, pointing to a moral retrogression…probably drink, [which] may account for the obvious fact that his wife has ceased to love him.10

Here is the sort of eye-popping Holmesian performance, barely a half-step from self-parody, that bedazzles both Dr. Watson and the reader. The man’s hat is large, so it is likely that he is “highly intellectual.” The hat has not been brushed, indicating that his wife “has ceased to love him.” The elastic band of the hat is broken and unmended, hence the wearer lacks foresight, a defect which means he is probably alcoholic. Innumerable commentaries have pointed out that the hypervigilance demonstrated in episodes like this one would serve as a sterling model for physicians, thereby brushing aside those aspects of the Holmesian method which would lead to medical disaster – the disregard for alternative hypotheses; the failure to discriminate weak clues from strong ones; and above all, the elevation of imagination over even the simplest of tests (e.g. “How well do you and your wife get on?”).

It is, after all, a lack of imagination, and not of logic, that allows Holmes to keep Watson in a perpetual state of befuddlement. There is no indication in the stories that Watson suffers as a medical diagnostician or that, once he had observed Holmes extract the nectar from a fragrant clue, he could not cultivate his own similarly attuned antennae. Watson’s deficiency, like the hapless Inspector Lestrade’s, is elsewhere. “You do not add imagination to your other great qualities,” Sherlock Holmes remonstrates with the “ferret-like” lawman in one of the stories.11 Indeed, Sherlock Holmes’s most famous statement regarding the logic of detective work, in the “Sign of Four”, is not logical at all. Having “excluded the impossible, whatever remains, however improbable, must be the truth.”12 In actual fact, excluding the impossible would seem to leave anything that is possible – or, roughly speaking, everything.

If Conan Doyle had remained a practicing physician deploying the pragmatic temperament of his profession, one might have attributed the fantastic element in the detective stories to the demands of fiction. But from the time of his early education in the forbidding climate of German Jesuit schools, Conan Doyle had been on a spiritual quest. When he discovered the work of the great skeptics of the nineteenth century, he joined them in heresy: “The evils of religion have all come from accepting things which cannot be proved,” he wrote.13 But the medical standard of proof would never do. His habit of mind was more nearly captured by the Holmesian manner, which looked upon the world as a teeming mass of telegraphically decipherable clues. One recalls how John Nash, the Nobel laureate of game theory – a genius who suffered recurrent episodes of schizophrenia – responded when he was asked how he could embrace both mathematical logic and psychotic delusions. I took my ideas about supernatural beings seriously, he said, because they came to me in the same way as my mathematical ideas.14

Conan Doyle, like Nash, seeing no obstacle to commingling ideas from two unrelated realms, took up spiritual questions as he had taken up the fictional depiction of Sherlock’s uncanny powers.  He resembled his own hero in perceiving the world as a revelatory text dense with nano-clues awaiting decryption. The difference was that these clues were no longer attached to malefactors.  Instead, they explicated the interpenetration of our lives by the spirit world – a world of ectoplasm and disembodied essences, where communication with the dead was as much a rational undertaking as entering the minds of criminals.

It began with experiments in telepathy. Relying on the assistance of a neighbor, Conan Doyle found he could produce diagrams which were “approximately” duplicated by his blinded collaborator seated six feet away.15 It must follow without “any doubt whatever” that thoughts could be shared across a distance of a thousand miles. This revelation astounded him, but having “sworn by science,” what else could he conclude? Still engaged in the practice of medicine, he found time to conduct séances, receiving literary advice from the spirit world (“Do not read Leigh Hunt’s book!”), observing always that medicine and spiritualism both demanded the highest standard of proof. To his regret, he could not afford a professional medium, a handicap he likened to performing astronomical investigations without a telescope.

By 1892 he had become a member of the Psychical Research Society, eagerly taking up the revelations in its weekly newsletter with the credulity of a real-life Dr. Watson. But it was in these days, too, that the good fortune that had favored him for so long began a disconsolating retreat. Now the father of two young children, Conan Doyle learned that tuberculosis had claimed his beloved wife. The illness was of a highly virulent kind – galloping consumption, as it was then called. He was advised to prepare for the worst – in a matter of months, perhaps. (In the event, his wife survived thirteen years, undoubtedly a tribute to Conan Doyle’s unstinting care).

And yet, paradoxically, his physical energy, which had always been extraordinary, was amplified still more by tragedy. During the years of his wife’s illness, he served in the Boer War as a physician volunteer and ran unsuccessfully for a parliamentary seat, all the while extending his literary work to historical fiction, science fiction, memoirs, and plays. His philosophical temperament, too, was sharpened and hardened by the ordeals of those years. The occasional seance no longer satisfied him. His capitulation to the psychic world took a form familiar in the annals of pseudoscience:  the skeptic who claims to have been brought to an acceptance of the supernatural over his own fierce objections, surrendering reluctantly to evidence only a fool could ignore.

When tragedy struck again – his eldest son died in 1918 of complications arising from injuries sustained at the Battle of the Somme during the Great War – the psychic realm to which Conan Doyle had returned so often became populated with ghosts. He wrote to the editor of the New York Times in 192315 a pulpit-worthy defense of spiritualism, revealing just how much the principles of science and the allure of romance had become entangled in his mind. He recalled for his readers that a “German savant” had demonstrated the existence of ectoplasm to 100 men of science, including twenty-three university professors, convincing all of them. Conan Doyle himself had had intimate conversations with his dead son in the presence of witnesses.

In the face of such proofs skepticism, he wrote, was “inexcusably ignorant or willfully perverse.” Had not Eva Carrière, the well-known psychic medium, produced from thin air a viscous substance – i.e. a spirit visitor – while deep in trance? Had not this ectoplasmic exudation spilled palpably onto Eva’s feet? True, it pleased the great Houdini, the self-confessed skeptic who witnessed this apparition, to say that it looked to him to be regurgitated food. But this was the kind of error that revealed how even elementary deduction was inaccessible to those who have not been schooled in it.

Of course, nothing about Conan Doyle’s descent into fantasy diminishes him in any way as an artist. Neither should it diminish the delight the ingenious and imperishable stories have given us. After leaving medicine, Conan Doyle continued to give comfort to millions, but like the comfort he wished for himself, it was of an aesthetic and spiritual kind beyond the reach of medicine. Out of his unease at fortune’s tempests and his longing for order, he created a universe in which all human mysteries could be made to surrender their secrets to the preternaturally-tuned intellect, and in which grief is appeased by the illusion of eternal life. It is a universe alien to medicine, which deals harshly with the clinician who allows his conclusions to be shaped by wishful thinking. And yet it is arguably a universe even physicians, who are among Conan Doyle’s most devoted readers, are rewarded for visiting from time to time.

In his valedictory address to his readers, after the last Sherlock Holmes story had been written, Conan Doyle laid out his artistic goal to an adoring audience: it was to provide “a distraction from the worries of life…that can only be found in the fairy kingdom of romance.”2 But fantasy and romance had always been his métier, and these virtues could hardly be maintained without seeking some escape from human suffering. It is no dishonor to the basic decency of the man that he chafed from the start at the harsh realities of the medical career that others had chosen for him.  Impatient with the world of pain and loss, he discovered that every mystery would give up its secrets when logic was turned upon the clues that lie unexamined all around us – including the greatest, most terror-filled secret of all. Leaving behind him a cast-off religion and a discarded profession, but with a reverent grip on his imaginative gifts, he labored nearly a lifetime to defeat death, inventing a refuge that might stand everlasting in a fictional fairy kingdom. How surprising can it be that he then chose to live in it?

 

 References

  1. Rodin, AE & Key JD. Medical casebook of Doctor Arthur Conan Doyle: from practitioner to Sherlock Holmes and beyond. Krieger Publishing Company, 1984, p 67.
  2. Doyle AC. Mary’s Hospital: Introductory address on “The Romance of Medicine.” Lancet. 1910;(Oct 8):1066-1068.
  3. Doyle AC. Memories and adventures. Cambridge University Press, 2012, p 22.
  4. Doyle, Memories and adventures, p 27.
  5. Doyle, Memories and adventures, p 87.
  6. Doyle AC. Gelseminum as a poison. Br Med J. 1879;2:483.
  7. Doyle AC. Memories and adventures, p 65.
  8. Peterson MJ. The Medical Profession in Mid-Victorian London. Berkeley: U of Calif Press, 1978.
  9. Flach PA & Hadjiantonis A, eds. Abduction and Induction: Essays on their relation and integration. Vol. 18. Springer Science & Business Media, 2013.
  10. Doyle AC. The adventure of the blue carbuncle. In The Complete Sherlock Holmes. Garden City: Doubleday, 1927, p 246.
  11. Doyle AC. The adventure of the Norwood builder. In Complete Holmes, p 501.
  12. Doyle AC. Sign of Four. In Complete Holmes, p 111.
  13. Doyle AC. Memories and adventures, p 27.
  14. Nasar, Sylvia. A beautiful mind. NY:Simon and Schuster, 2011.
  15. Doyle AC. Letter to the Editor: Conan Doyle’s Proof. NY Times, Mar 3, 1923.

 


 

MICHAEL D. SHULMAN holds a PhD in clinical psychology from Fordham University and a medical degree from the Perelman School of Medicine at the University of Pennsylvania. He is retired from the private practice of nephrology.

 

Spring 2018  |  Hektorama  |  Physicians of Note