The doctor who diagnosed

his patients before they

had uttered a word

Barbara Millar

 

'This, gentlemen,' he announced, 'contains a very potent drug. To the taste it is intensely bitter. It is most offensive to the sense of smell. But I want you to test it by smell and taste: and, as I don't ask anything of my students which I wouldn't be willing to do myself, I will taste it before passing it round.'
     He dipped his finger into the liquid, and placed it in his mouth. The tumbler was passed round. With wry and sour faces the students followed the professor's lead. One after another tasted the liquid: varied and amusing were the grimaces made. The tumbler, having made the rounds, was returned to the professor.
     'Gentlemen,' he said, with a laugh. 'I am deeply grieved to find that not one of you has developed this power of perception, which I so often speak about; for if you watched me closely, you would have found that, while I placed my forefinger into the medicine, it was the middle finger which found its way into my mouth.'
     Such were the methods of Dr Joseph Bell – recounted in an essay by Dr Harold Emery Jones. They impressed one of his pupils so much that, later, he would evolve his eminent medical professor's characteristics into one of the world's most famous fictional detectives.
     Joseph Bell was born in 1837, the great-grandson of Benjamin Bell, a forensic surgeon considered by many to be the first Scottish scientific surgeon, following the publication of his influential textbook 'A system of surgery', a best seller throughout Europe and the United States. Bell's main contribution to surgical practice was his adage 'save skin', which led to improved rates of wound healing in operations – and he was also an early advocate of routine pain relief in surgery.
     Bell was the progenitor of one of the great Edinburgh surgical dynasties – his son Joseph, grandson Benjamin and great-grandson Joseph were all surgeons in the city and all became presidents of the Royal College of Surgeons in Edinburgh. Another relative was Scottish anatomist Charles Bell, who described (and had named after him) the condition of facial paralysis known as Bell's palsy.
     Joseph Bell became professor of clinical surgery at Edinburgh University and whenever Queen Victoria was in Scotland, he was her personal surgeon (and later honorary surgeon to Edward VII). For 23 years he was editor of the Edinburgh Medical Journal and he was a popular lecturer, his lectures invariably attended to capacity. It was at one of these lectures that a 17-year-old medical student – Arthur Conan Doyle – first met Bell, then 39, and was immediately impressed.
     Doyle was a first-rate student and, by the end of his second year at medical school, Bell selected him to be his clerk and assistant at the Royal Infirmary's open clinic. Bell's ethos in teaching the treatment of disease and accident was that 'all careful teachers have first to show the student how to recognise accurately the case. The recognition depends in great measure on the accurate and rapid appreciation of small points in which the diseased differs from the healthy state. In fact, the student must be taught to observe. To interest him in this kind of work we teachers find it useful to show the student how much a trained use of the observation can discover in ordinary matters, such as the previous history, nationality and occupation of a patient'.
     Conan Doyle often heard Bell make amazing deductions while leading students on his rounds. On one occasion he witnessed Bell tell students that a new patient was a recently discharged non-commissioned officer who had been serving in a Highland regiment stationed in Barbados. 'You see gentlemen,' he explained. 'The man was a respectful man but did not remove his hat. They do not, in the army, but he would have learned civilian ways had he been long discharged. He has an air of authority and is obviously Scottish. As to Barbados, his complaint is elephantiasis, which is West Indian, and not British.'

 

     On another occasion when Doyle was also present, a man's address, combined with the callused ball of his thumb, indicated to Bell that he was a sail maker – he lived on a street near the docks and sail makers typically had calloused thumbs from stitching the heavy canvas sails.
     Conan Doyle described Bell as 'a thin, wiry, dark man with a high-nosed acute face, penetrating eyes, angular shoulders'. Dr Bell 'would sit in his receiving room with a face like a Red Indian, and diagnose the people as they came in, before they even opened their mouths. He would tell them details of their past lives; and hardly would he ever make a mistake'. Dr Harold Emery Jones added: 'He was always alert, always up and doing, nothing ever escaped that keen eye of his. He read both patients and students like so many open books. His diagnosis was almost never at fault'.
     If a person had tattoos, he would know where their travels had taken them; he could identify different accents; he would watch people's gait – the walk of a sailor was distinctly different from a soldier – he had a remarkable ability to deduce a great deal about a patient. But, as well as being a brilliant doctor, publishing several medical textbooks, Bell was also an amateur poet, a sportsman and an avid birdwatcher, for which activity he inevitably sported a deer-stalker and cape, rather eerily similar to the portrayal of Holmes by actor Basil Rathbone in the black and white film versions of the stories.
     In creating Sherlock Holmes, his fictional detective, Arthur Conan Doyle admitted he was based on Bell. In a letter to Bell from Conan Doyle and still in the hands of the Sisted family, descendants of Bell, is written: 'It is most certainly to you that I owe Sherlock Holmes. Though in the stories I have the advantage of being able to place him (Holmes) in all sorts of dramatic positions, 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. Round the centre of deduction and inference and observation which I have heard you inculcate, I have tried to build up a man who pushed the thing as far as it would go, further occasionally'.
     It is also believed that Dr Watson – Holmes' sidekick – was based on a Dr Patrick Heron Watson who, ironically, Bell did not like at first, although he later overcame his objections and they would often dine together. He was also a medical doctor and had a similar background to Conan Doyle's Watson, serving as a surgeon in the Crimean War, while the fictional Watson was sent to Afghanistan. Conan Doyle's medical training influenced much of his work – he soaked up a lot of information from his life in Edinburgh and regurgitated it in some form in his writings.
     Bell, who had married Edith Erskine Murray, with one son, Benjamin, died in October 1911 – 100 years ago, and was always modest about his contribution to Conan Doyle's Holmes. But he was most complimentary about the author. 'Dr Conan Doyle's education as a student of medicine taught him how to observe, and his practice was a splendid training for a man such as he, gifted with eyes, memory and imagination. Eyes and ears which can see and hear, memory to record at once and recall at pleasure, the impressions of the senses, and imagination capable of weaving a theory or piecing together a broken chain or unravelling a tangled clue'.

 

Barbara Millar is a tour guide and freelance journalist