This 1996 article is being reposted with kind permission from the author, Dr Craig Hilton, who creates cartoons under the name of Jenner. Dr Hilton first delivered this text as a presentation for the Sherlock Holmes Society of Western Australia on the 25th May, 1996. You can see Jenner's work at Doc Rat.
When I was researching The Adventure of the Colonial Boy, I remembered this essay and it was one of my first ports of call for looking at Watson's medical history and 19th Century knowledge for the story. I extrapolated considerably, and also assumed that John was downplaying his skills in the stories - but this is where I began.
John Watson - The Good Doctor?
Doctor Watson, as everyone in the English- and non-English-speaking world can tell you, is the companion of Sherlock Holmes, the rather-less-bright sidekick to the great detective and second member of the renowned sleuthing partnership. People who don't know him from the original Conan Doyle stories are still aware of him through the thousand movies, TV and radio programmes, associated literature, pastiches, parodies and any other representation of the legend. To most people, Holmes and Watson are more icons than literary creations, shaped mostly by mental images of Basil Rathbone and Nigel Bruce. If you asked your aunt to give a brief description of Doctor Watson, you could bet your bottom dollar she'd use the word "bumbling" at some stage.
Now I don't think anybody in his right mind would let himself be treated by a GP of the Nigel Bruce version, except perhaps someone keen on being poisoned with the wrong prescription. But the true Watson of the Canon was obviously a little more competant than that. He was more along the lines of Edward Hardwicke or David Burke, a man probably gifted with above average intelligence, considerable education, a great deal of passion and sympathy but with a fairly conventional imagination. He had all the makings, some might say, of an excellent general practitioner.
So was he? I am looking in this essay to explore the truth of the matter. But before I can answer this, first we'll have to know a little about the man, the history of his career, the history of general practice, the state of the art at his particular time, and only then can I search the pages of the books for evidence of his performance.
John Watson: Doctor and Soldier
John Hamish Watson was born in England in the early 1850s (1852 by some accounts), and after the death of his mother, he and his brother Henry Jr were taken by their father to spend some of their boyhood in the Australian goldfields. Returning to England, John was educated at a good school, thence proceeding to the University of London Medical School in about 1872 to pursue a medical degree. He was a staff surgeon at St Bartholomew's Hospital in London. In 1878 he was given his degree, and from here he went to Netley to take the course for surgeons in the Army. Having completed this, he was attached to the Fifth Northumberland Fusiliers as assistant surgeon, but on travelling to India to join them he learned that with the outbreak of the second Afghan War his corps had advanced far into enemy territory. He succeeded in regaining them in Kandahar, where he set about his duties.
Watson says that the campaign brought him nothing but misfortune and disaster. He was removed from his brigade and attached to the Sixty-sixth Foot (Berkshires), with whom he served in the "fatal battle of Maiwand" on the 27th July 1880, extremely lucky in fact to have escaped with his life. Recovering from his wound in Peshwar, his fortunes even then took a turn for the worse when he contracted enteric fever, and at last he was given his passage home to England to recover for the next nine months on an army half-pension. This was in 1881, and from the time he set foot on Portsmouth jetty, health "irretrievably ruined", Doctor Watson's time with Holmes was about to begin, and their subsequent adventures together are a matter of record to all good Sherlockians.
John Watson: GP
We know a lot from this time about his companionship in the game of detection. What about his day job? Well it seems to have been closely bound to his domestic circumstances, in that throughout his life the doctor worked when he was married and didn't when he was not. He lived with Holmes from 1881. He may have been married in 1885 and widowed in the next couple of years. Of certainty is that in 1888 the doctor married Mary Morston, moved out of digs with Holmes and bought a practice in Paddington, obviously to support his new wife. When he did go with Holmes on one of his cases he had to employ a locum to deal with his heavy caseload. In 1890 they moved to Kensington, where conversely his practice was "small" and "never very absorbing".
Things started to go downhill. In 1891, his dear friend Holmes was apparently killed in the line of duty, his wife Mary died in next few years and I am not at all surprised at the evidence that Watson's general condition had begun to suffer the effects of these depressing episodes. However, Holmes made his return large as life in 1894, and within the year Watson had sold his practice to take up again with the great detective. This move had the suspicious hallmarks of having been engineered, as it later turned out the man who had bought it was one of Holmes' relatives.
Watson again lived with Holmes and solved crimes with him until 1902. Whether he was also practising as a doctor at the same time is speculative, but I doubt it. Nevertheless in short order he was married again and consequently back in practice as a breadwinner. He did well too - it was described as "not inconsiderable". Holmes retired in 1903, but Watson kept doctoring on, having little further contact with him. The medical career from then on, up until and including his service in the Medical Corps at the start of World War One, has little to do with the John Watson we know from the Canon. Details are not available but one can assume things passed without any great event.
So what do we have in summary? After graduation Doctor Watson trains as an army surgeon, serves as one briefly, takes a seven year break, commences work in his very first general practice at the age of thirty-six, does this for seven years (88 - 95) and after a further eight-year break resumes it when he is fifty, once he has fairly well finished his association with Holmes. It seems he only worked for the money - no sooner was he free from a financially dependent wife than he would chuck it in.
Watson, as I have said, was a general practitioner. Though trained as a surgeon, he hung up his shingle in London as a family doctor, which was a common enough thing to do in his circumstances. General practice was a burgeoning field of medicine by the Victorian age, and in those days it simply meant a registered medical practitioner who had not gone on the enter the Royal College of Physicians or of Surgeons. It was the mainstream of medicine, which took all comers, handled every malady or misadventure that could be thrown at it and dealt with the highest to the lowest strata of society. It still does, by the way.
The History of Medicine
The history of General Practice as a specific discipline is long and tortuous. Medicine itself is as old as prehistory and has had a myriad of practitioners, but the modern Anglo-Saxon medical system we know today has its roots in three main groups. Firstly there were the physicians whose charter dated back to the time of Henry VIII. There were also the surgeons, who were lumped in with barbers by Edward IV in 1462 but managed to shake them off again with the founding of the Royal College of Surgeons in 1800. The third group were the apothecaries, who could trace their origins back to mediaeval times from the itinerant medicine sellers not far removed from grocers. By charter in 1617 the medicine sellers were allowed the exclusive right to keep a shop with bottled leeches and potions of various kinds. Quick to keep them in their place, the physicians obtained an order forbidding apothecaries to prescribe medicine, but come 1663 and the Great Plague the tables were turned. It was noted the physicians had been the ones who picked up their gear and left town while the apothecaries stayed to care for the ill. England never forgot this, it seems, and in1703 the high court ruled that the office of the apothecaries was to diagnose and treat disease, and a further ruling in 1829 added that they could actually charge for it.
The Apothecaries Act of 1815 declared that only those licensed by the Society of Apothecaries could legally practise as one. Becoming registered involved a five year apprenticeship, a six month hospital attachment and final exams. This was a momentous step which gave apothecaries standing in their own right. In 1830, following a test case in the courts where an apothecary successfully sued an attorney for the bill for his professional services, the editorial of The Lancet proclaimed that " the subordinate members of the profession, that is the general practitioners, have been raised 1000 degrees in the scale of professional respectability and 10000 degrees in the estimation of society". This was the first usage of the term "general practitioner", and it has remained the common descriptor ever since.
In 1858 the General Medical Council was established in England, a body given to maintaining standards and discipline through the whole of the medical profession. It set the requirements for training and examination of anyone who would be allowed to become a doctor. Indeed it allowed general practitioners to be addressed with the title of doctor, although the College of Physicians fought a fifty year battle against this. Women were allowed to join from 1876, and there was resistance against this move too.
Western Australia had a medically qualified governor between1862 and 1868. It was during his term that the state's first medical act was passed, which included the decree that "any person practising before 1869 [was] entitled to register, if necessary without the production of degrees, diplomas or certificate". That was in the Antipodes. Ten years later, in England, a youthful John Watson graduated from the University of London.
Medicine in 1890
So what was the current state of medicine - and general practice in particular - in England circa 1890? The germ theory of infectious diseases proposed by Louis Pasteur and Joseph Lister's antiseptic principles of wound management by been established for about twenty-five years. The germs causing elephantiasis had been known for about fifteen years and tuberculosis about ten. It would be another five years before Sigmund Freud would publish the results of his treatment of hysteria and Wilhelm Roentgen would discover the X ray.
Some of the diseases that doctors came up against were self-evident: pneumonia, anaemia, heart failure and the like, although the more subtle points of the various forms of these were still under scrutiny. There were others which through the experience of various practitioners had been described as falling into recognised patterns such as Paget's disease, Parkinson's disease and von Recklinghausen's disease, from those established for years to those still in evolution. Injuries were a practical problem to be dealt with in a time-honoured practical manner. Of the available drugs, digitalis had been in medicinal use for over a century, morphine for far longer, and there were aspirin, laudanum and such, but compared with what we nowadays take for granted the list was short and relatively powerless. Sulphonamides and penicillin, the first of the antibiotics, were fifty years into the future. It puts the whole of the discipline into perspective - how can you start to differentiate amongst the finer points of pneumonia when the best available treatment is still to rug up in bed with a woolly vest?
Let's look at the accounts of the author himself. Sir Arthur Conan Doyle wrote several non-Holmesian short stories on medical themes, which shed some light on his view of the position and capabilities of the craft. In Behind the Times Doyle describes an old fashioned family doctor who had flourished in the age of caring sans cure, through the eyes of a much younger doctor full of the modern ways of curing sans care. The younger describes the elder, a Doctor Winter, in his treating him from delivery and onwards through his childhood - "he vaccinated me, he cut me for an abscess, he blistered me for mumps" - a fair old therapeutic spread. The blistering, by the way, was moxibustion and involved the local application of heat or strong chemicals to create blisters on the skin, in the way a liniment or poultice might be used today, only a degree more invasive. Whether Doctor Winter had painted a substance on the young boy's cheeks or applied a naked flame to do the job, and whether or not the treatment caused more symptoms than it relieved, you and I know the superficial damage to the patient's skin would have done nothing to help his body rid itself of the virus. Nevertheless, blistering was in vogue up until the end of the century, at least for the likes of this GP.
The story goes on to reveal some of Doyle's own feelings about the ideal qualities of a family doctor. "But at last there came a time of real illness - a time when I lay for months inside my wicker-work basket bed, and then it was that I learned that that hard face could relax, that those country-made, creaking boots could steal very gently to a bedside, and that that rough voice could thin to a whisper when it spoke to a sick child."
More on the healing manner of this slightly-behind-the-times GP: " ... [H]e has the healing touch - that magnetic thing which defies explanation or analysis, but which is a very evident fact nonetheless. His mere presence leaves the patient with more hopefulness and vitality. The sight of disease affects him as dust does a careful housewife. It makes him angry and impatient. 'Tut, tut, this will never do!' he cries, as he takes over a new case. He would shoo death out of the room as though he were an intrusive hen. But when the intruder refuses to be dislodged, when the blood moves more slowly and the eyes grow dimmer, then it is that Doctor Winter is of more avail than all the drugs in his surgery. Dying folk cling to his hand as if the presence of his bulk and vigour gives them more courage to face the change; and that kindly, wind-beaten face has been the last earthly impression which many a sufferer has carried into the unknown."
You will appreciate the value Doyle placed on medicine's being an art as well as a science, and that the very best doctor was one who did not neglect that special quality of compassion. To illustrate this finally, and with apologies for giving away the punchline: when the narrator succumbs to the influenza during a severe outbreak he was treating, rather than his modern, educated young colleague to attend him at his sick bed, he calls for none other than the old-fashioned, kindly Doctor Winter.
Doyle had written most of his stories with the benefit of hindsight from the early twentieth century. We read them now in the far end of the twentieth century from a far loftier vantage point. To us, even more than to Doyle, it would seem that the best the new doctors of Watson's vintage could provide scientifically to their patients, even with their "modern instruments and [their] latest alkaloids" was for practical purposes not really much more than what was on offer from Doctor Winter - a few less leeches perhaps, one or two less blisters maybe, but not much more than that, at least by our modern day standards.
Sir Arthur Conan Doyle was a doctor himself, of course. Where Watson was described as having graduated in 1878, Doyle did so in 1881. Both chose general practice as their branch of medicine. Watson had a practice which obviously left him time to write (between engagements) and so did Doyle's. Doyle, in his career as a GP, worked with a young assistant named James Watson who was obviously the source of his character's name, and reputedly used a surgical lecturer called Joseph Bell as a source of inspiration for Holmes.
It's interesting that the cold, incisive surgical lecturer became Holmes and the GP Watson. Doyle was echoing the time-honoured impression of the physician and the surgeon being learned men on their pedestals and the general practitioner being the true doctor of the people. The stories could only have been the incredible successes they were by this very virtue, of Watson as Everyman, the compassionate doctor, proxy for you and me. While he does not dazzle us with medical science, it would be hard to imagine him giving the same comfort to Helen Stoner (The Speckled Band) if he was a didactic physician. It just wouldn't work.
Evidence from Canon
The Canon is very sparsely supplied with good descriptions of Dr Watson hard at work. In The Adventure of The Engineer's Thumb, he is shown dealing with one Victor Hatherley for a surgical emergency in the form of an amputated digit. With his experience as an army surgeon on the battlefield, this one must have been a piece of cake. He says he "sponged the wound, cleaned it, dressed it, and finally covered it over with cotton wadding and carbolised bandages." I can't fault that.
Mr Isa Whitney is the patient in The Man With the Twisted Lip, in which Watson is summoned on one of those house calls we doctors wish we could do without. It's the "sorry to disturb you at home at this hour, doctor, but you must go across town to a seedy, low dive and make my husband come home and see sense and give up drugs for good. He'll listen to you" variety. The episode gives little idea of Watson's clinical acumen but speaks volumes for his forbearance.
There are a lot of times we might have had the chance to watch his emergency resuscitation drill, with Blessington (in The Resident Patient), Mr Hilton Cubitt (in The Dancing Men), Charles Augustus Milverton and many more, but each time he was either too late or not in a position to help with the hangings, shootings, stabbings and other sundry demises. He would have had a crack at diagnosing Holmes' "fatal" malady in The Adventure of the Dying Detective if he'd been allowed to approach the bed, although since the illness was all a put-up job as part of a cunning plan, this would have defeated the purpose rather.
And I do note his extreme concern over his friend's cocaine habit, of which he very sensibly disapproved. If only he had had the same passion against the killer weed tobacco.
How did he fare in the management of the patients in his practice? Well, they seemed to keep coming back (except at his Kensington practice, the one which for some unaccountable reason was small and never very absorbing - draw your own deductions), so either they were pleased with his results or he had taken a leaf out of Doctor Winter's book of bedside manner, or both. From this we can assume he performed at least as well as any other general practitioner, an amazing feat for a retired army surgeon out of practice for seven years. And his ability to diagnose? This might be surmised by his capacity (or lack thereof) to solve the puzzles that both he and his detective companion came up against. Was there ever an occasion that Holmes said "I see you have been talking with your stockbroker" and Watson replied "That was clever, Holmes, and I bet I know how you worked that one out"? Not that I can remember. And cast your mind to The Sign of Four, with a classic "locked room" murder: Holmes with an over-elaborate patience explains to the good doctor how the perpetrator made good his escape. Since both the door and the window are locked from the inside, the only possibility, however improbable, is the dirty great hole in the ceiling. I mean, I know it's a two horse race with Holmes as Silver Blaze, but sometimes Watson doesn't even rate a distant second.
Nowadays, this degree of dullness in the consulting room wouldn't be tolerated for an instant, not even with all the warmth and compassion, nor antibiotics and X rays in the world. Standards are higher, goals must be met, and a friendly hand on the shoulder is still no substitute for an acceptable result. At the same time, general practice is rising in stature relative to that of the physicians and surgeons, and a modern day Watson could not assume he could drift into it as a soft option whenever he needed a bit of ready cash to support his latest wife.
John Watson: Verdict
Now, if the Watson of today had had the opportunity for modern medical schooling before being unleashed on the population at large, he may have done all right. If he had chosen a career in general practice and undergone the undergraduate and postgraduate training, his genuine compassion, dedication and interpersonal skills would probably have helped carry him through, and for one I should certainly like to have met him.
When it comes to the end of things, Doctor Watson was a man you could trust. He was as honest as he was dedicated, and if he didn't spend his whole working years solidly behind a GP's desk it was only because he didn't let his one profession dominate his life. We his readers could not have known Holmes in the way we do, had not his zealotry been viewed through Watson's stability, his cold analysis through Watson's empathy, and his specialisation through Watson's well-rounded comprehensivity. Stability, empathy and comprehensivity - you couldn't want for better qualities in a general practitioner. In his diagnostic and therapeutic limitations he was on a par with all of his late nineteenth century colleagues, but in the medical qualities - and the truly human ones - held by Sir Arthur Conan Doyle to be the most fundamental to his craft, John Watson was indeed The Good Doctor.
Bunson, Matthew E. Encyclopaedia Sherlockiana. Macmillan, 1994.
Leavesley, J.H. Medical Byways - Famous Diseases and Diseases of the Famous. ABC Books, 1984.
Leavesley, J.H. Stand Up The Real Sherlock Holmes. Narrated on ABC Radio, unpublished.
The Marshall Cavendish Learning System. The Story of Medicine. Marshall Cavendish Books Ltd, 1969.
Conan Doyle, Sir Arthur. "Behind The Times", collected in The Conan Doyle Stories. John Murray, 1929.
Conan Doyle, Sir Arthur. A Study in Scarlet et.al.
- Study in Scarlet, Bristol Observer 1890
- Study in Scarlet, Richard Gutschmidt (1902)
- Paget illustrations from Internet Archive