Rida Khan
New York, United States

In “A Scandal in Bohemia,” Sir Arthur Conan Doyle’s first short story within his renowned Sherlock Holmes series, the titular character engages in a lighthearted battle of wits with his companion and right hand, Dr. Watson. After Sherlock explains his process of deduction, a rather chagrined Dr. Watson states, “When I hear you give your reasons…the thing always appears to me to be so ridiculously simple that I could easily do it myself, though at each successive instance of your reasoning I am baffled until you explain your process. And yet I believe that my eyes are as good as yours.” Sherlock Holmes then resolutely declares, “You see, but you do not observe.”¹ Such a statement begs the question—what is the difference between seeing and observing?

From 1876 to 1881, Arthur Conan Doyle studied medicine at the University of Edinburgh. Even as a student, Doyle was unconventional in his approach to learning. For example, he self-administered gelsemium to investigate its toxic effects, despite the fact that this flowering plant was already known to be potentially fatal. When he discovered that the maximum tolerable dose was higher than what previous literature suggested, Doyle published his findings in the British Medical Journal, earning him some notability within the medical field.^2,3

After graduating, the future author searched for work that married his interests in medicine and adventure. He found this in a position as a ship surgeon on a steamer bound for West Africa. His experiences at sea inspired a collection of short stories entitled The Captain of the Polestar and Other Tales.³

After practicing as a ship surgeon, Doyle began to foster an interest in ophthalmology. In letters to his sister, he wrote, “I should go to London and study the eye. I should then go to Berlin and study the eye. I should then go to Paris and study the eye. Having learned all there is to know about the eye, I should come back to London and start as an eye-surgeon…” He did, in fact, end up in Vienna to train in ophthalmology, and upon his return to London, established a clinic specializing in refraction and retinoscopy.²

Because his practice was not very busy, Doyle found himself with the perfect conditions to create. It was within the realm of medicine where the idea and design of Sherlock Holmes was born, a detective with astute powers of observation and reasoning. Given his medical background, it is not surprising to know that Holmes was largely based on Doyle’s own mentor in Edinburgh. Dr. Joseph Bell, a Scottish surgeon who served in the Royal Infirmary, was known for his genius ability to diagnose confounding diseases and draw correct conclusions about his patients’ lives. Several anecdotes describe Dr. Bell’s ability to identify his patients’ occupation, residence, and even where they had recently journeyed—all by simply observing. Doyle himself would credit the doctor as his inspiration, as he wrote in a letter, “It is most certainly to you that I owe Sherlock Holmes . . . I do not think that his analytical work is in the least an exaggeration of some effects, which I have seen you produce in the outpatient ward.”⁴

Dr. Bell once told a reporter that every good teacher must encourage good students by allowing them to “cultivate the habit of noticing the little apparent trifles.”⁴ As Doyle’s teacher, he most certainly would have done the same for the author, which explains the conception of his greatest literary creation, and perhaps his career decisions as well. Ophthalmology, a specialty known to be quite detail-oriented, is not only a discipline requiring careful deduction, but also one built entirely around these abstract, yet tangible, ideas of “seeing” and “observing.”

To an ophthalmologist like Doyle, the eye may represent many things. It is an organ with the unique function of relaying visual information via the optic nerve, allowing humans to “see.” But it is also a symbol of perception and perspective, as this visual information is then processed into something meaningful by the brain, allowing humans to “observe” and make sense of their surroundings.

When Dr. Watson proposes that his eyes are the same as Sherlock’s, the detective reminds him (and thus, the author reminds the audiences) that sight should not be conflated with perceiving. It is perhaps something Doyle learned from his own experiences in his practice—those with the ability to see may not be able to observe; and those without the ability to see may still be able to observe, and perhaps even more astutely than others.

While Sherlock Holmes understands ophthalmology quite well, as evidenced by several of his deductions relating to eye surgery and disease, it is perhaps his ability to thoughtfully examine that gives him greater merit. And, as Dr. Watson suggests, it does not take a superior eye, but rather attentive compassion. With Sir Arthur Conan Doyle’s background in medicine and ophthalmology, it becomes apparent that to “see” is a privilege, but to “observe” is a skill requiring practice and patience. Differentiating between the two is, after all, elementary.

References

1. Doyle AC, Macaluso JP. A Scandal in Bohemia. London: MX Publishing; 2016.
2. Sen M, Honavar SG. Sir Arthur Conan Doyle: The Adventures of a Literary Ophthalmologist. Indian Journal of Ophthalmology. 2021;69(12):3394-6.
3. Fallon E, Harmon A, Harrington D: Sir Arthur Conan Doyle, MD: Ophthalmologist, Author, and Defender of Justice. American College of Surgeons, March 4, 2022. Available at: https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2022/03/sir-arthur-conan-doyle-md-ophthalmologist-author-and-defender-of-justice/. Accessed July 21, 2024.
4. Patel SR, Best SL, Rabinowitz R. Sherlock Holmes and the Case of the Vanishing Examination. The American Journal of Medicine. 2018;131(11):1270-1.