Filler

Observe cases minutely, improve in my profession, write to the Lancet

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39416.469595.AD (Published 20 December 2007) Cite this as: BMJ 2007;335:1315
  1. Frank Rugman, consultant haematologist
  1. 1Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT
  1. frank.rugman{at}blueyonder.co.uk

    So wrote Arthur Conan Doyle to his mother on qualifying in medicine from the University of Edinburgh in 1881. But the creator of Sherlock Holmes had already published a letter in the BMJ while a medical student.1

    In his third year, he worked as a dispensing assistant to Reginald Hoare, a general practitioner in Aston. Conan Doyle had developed symptoms of persistent neuralgia and taken tincture of Gelseminum sempervirens, the dried rhizome and root of yellow jasmine. Its effects resemble those of nicotine, but with stronger depression of the central nervous system.

    He increased the dose incrementally from 40 minims (2 ml) on the first day to 200 minims (10 ml) by the seventh. Conan Doyle reported his resulting symptoms; initial “giddiness,” difficult eye accommodation, headaches, and diarrhoea with severe depression on the final day. Although his BMJ letter describes the drug’s side effects, he must have known that deaths from respiratory arrest had been reported with Gelseminum.

    Self experimentation reappears in his MD thesis on vasomotor changes in tabes dorsalis.2 Conan Doyle described experimenting with nitroglycerine as a vasodilator before using it on his first patient.The dose beginning with one drop may be safely increased to twenty, a congestive headache being the first sign of overdose. I have myself taken as many as forty minims without inconvenience.”

    Conan Doyle wasn’t the only self experimenting doctor in the 19th century. In the 1880s Sigmund Freud brought the effects of cocaine to the attention of the medical world but also sampled them himself: “In my last severe depression I took ‘coca’ again and a small dose lifted me to the heights,”he wrote to his fiancée. 3

    Freud abandoned his interest in cocaine just as his colleague Karl Koller began experimenting with its use as an anaesthetic in eye surgery. Conan Doyle visited the ophthalmology department at Vienna Hospital in 1891 and became aware of the toxicity of cocaine.

    But what of the fictional Sherlock Holmes, who became addicted to cocaine? Did his addiction begin in the same spirit of self experimentation shown by his creator’s explorations of Gelseminum and nitroglycerine? In the Sign of Four, Dr Watson admonishes Holmes for his cocaine addiction: “Count the cost! It is a pathological and morbid process, which involves increased tissue change and may at least leave a permanent weakness.”

    Footnotes

    • Competing interests: None declared.

    References

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