“When you have eliminated the impossible, whatever remains, however improbable, must be the truth." [SIGN]
These are some of the immortal words uttered by Sherlock Holmes, over the course of his illustrious career in the story of The Sign of the Four. Supposedly Arthur Conan Doyle’s inspiration for this was taken from his medical training where one is taught to list all the possible diagnoses for a given condition, and try to eliminate those one after the other based on clinical parameters.
I think one could parse these words a bit, especially the word impossible, but that would be for another day! I've picked out a few medical oddities along the Canonical journey for your consideration.
In the Speckled Band, Dr. Roylott’s death was caused by an Indian snake and he supposedly died within 10 seconds.
There are two major types of venom: the hemotoxic and the neurotoxic . While the neurotoxic acts by paralysis of the respiratory muscle and the hemotoxic acts by clotting the blood within the circulation, neither of them will kill in 10 seconds. It will take many minutes at its fastest, and usually slower than that. This particular snake was identified to be a viper which produces a hemotoxic poison, which acts slower than a neurotoxin.
Apparently one Mr. Klauber (per Mr. Baring-Gould’s book) postulated that this snake could have been a hybrid of a Gila monster and a cobra, created by the Infamous Doctor Roylott, (a la Frankenstein) and thus capable of going fast up and down the bell-pull rope, and also having a very deadly bite!
This seems very far-fetched, but does allow Mr. Klauber to give full reign to his imagination!
The more prosaic explanation is that Dr. Arthur Conan Doyle was just exercising a bit of poetic license.
In the Naval Treaty, after the valuable naval manuscript went missing , Mr. Percy Phelps reports that he was unconscious for 9 weeks with “brain fever" and before that he was “practically a raving lunatic"!
During Victorian times “brain fever” would encompass a lot of mental health states, and this sounded like a “nervous breakdown” but it is impossible for one to be unconscious for 9 weeks from it.
Interestingly, the modern day interpretation of brain fever could be stated as encephalitis, most commonly caused by viruses. St Louis has the dubious distinction of having one such virus named after it.
Now, if one had a viral encephalitis, one could possibly be unconscious for a long period like the nine weeks mentioned in the story. One interesting explanation could be that mental stress can decrease the body’s immune responses, and what if Mr. Phelps' stress actually made him susceptible to a viral encephalitis at that time? Just a thought as we will never know!
In the opening passage of The Priory School, Dr. Thorneycroft Huxtable entered their rooms at Baker Street and fell down and becomes “insensible." Dr. Watson postulates it to be “absolute exhaustion - possibly mere hunger and fatigue."
His face is described as “heavy white" with “leaden color.” All these suggest that this gentleman actually had a vasovagal episode also known as a fainting spell!
This condition usually does not produce a thready pulse described, “where the stream of life trickled thin and small.” Usually it does produce a slowish and reasonably strong pulse and the diagnosis of a fainting spell is further reinforced by the fact that he “scrambled up in an instant." Travelling 6 hours on a train can't be that exhausting to cause one to faint.
All these are my views from the perspective of a health care provider and I do realize there can be other interpretations, but I did have fun putting my thoughts down, and I hope you all enjoy those as well.
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