Abstract: FRI-17
Sources of Funding: None

Introduction

The increasing use of technology has affected how we practice medicine such that there has been concern regarding the lost art of taking a history and physical exam. Sir Arthur Conan Doyle, who was also a physician, based his character, Sherlock Holmes, after one of his professors, Dr Joseph Bell from the University of Edinburgh, known for his legendary diagnostic abilities.

Methods

We reviewed the medical literature and media text regarding the decline in the application of physical diagnosis in medicine. We researched texts and historical articles written about and by Sir Arthur Conan Doyle and Joseph Bell, compiling a list of anecdotal stories on Dr Bell's diagnostic abilities. We read all of the adventures of Sherlock Holmes as well as visited the Sherlock Holmes Museum in London.

Results

Arthur Conan Doyle studied medicine from 1876 to 1881 at the University of Edinburgh where he met Dr Joseph Bell and served as his clerk in the Edinburgh Royal Infirmary. After creating the character of the famous detective, Conan Doyle would write to Bell, "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."

Dr Joseph Bell (1837-1911) was a Scottish surgeon who was known for his legendary diagnostic intuitions. Medical students and patients alike would be astonished by his observations as Bell would often describe their symptoms and give details of their past life unprompted. Conan Doyle in his autobiography would write "I thought of my old teacher Joe Bell... If he were a detective he would surely reduce this fascinating but unorganized business to something nearer to an exact science."

As his clerk, Conan Doyle was known for taking copious notes of Bell's cases, which would serve as models for Holmes' deductions. As a professor, Bell trained his amateur "Watsons" in the habit of observation.
In one classic anecdote: "A total stranger was brought to his clinic... While observing him, Bell spoke. [Well, my man, you've served in the army.] (Aye, Sir.) [Not long discharged?] (No, sir) [A highland regiment?] (Aye, sir) [Stationed in Barbados?] (Aye, sir) Bell explained to his students, 'You see gentlemen, the man was a respectful man, but did not remove his hat. They do not do so in the army, but he would have learned civilian ways had he been long discharged. He had an air of authority and was obviously a Scot. As to Barbados, his complaint is elephantiasis, which is West Indian and not British.' "

Dr Bell would write an essay entitled "Mr. Sherlock Holmes" comparing Holmes' skills to that which a physician and surgeon must master. He would write "Try to learn the features of a disease or injury as precisely as you know the features, the gait, the tricks of manner of your most intimate friend. Him even in a crowd, you can recognize at once; it may be a crowd of men dressed alike... and yet, by knowing these trifles well, you make your diagnosis or recognition with ease."

Conclusions

It is from the cases of Sherlock Holmes and the real clinical cases of Dr Joseph Bell that we are reminded to spend time observing and talking to our patients despite the technological tools at our disposal. It is only with the application of observation and deduction that we can go from being Watson to a true surgical sleuth like Dr Joseph Bell.