The healthy skepticism which medical training induces, the desire to prove every fact, and only to reason from such proved facts—these are the finest foundations for all thought.
—ARTHUR CONAN DOYLE, “THE ROMANCE OF MEDICINE”
By the time Arthur enrolled in 1876, the University of Edinburgh was a renowned center of medical education. The Royal College of Surgeons was founded in 1505, during the reign of James IV, its “Seill of Cause” granted in response to a bill of supplication presented by “Surrgeanis and Barbouris within the Burgh of Edinburgh.” At the time, alongside scourges and hanging, other royally approved public torture included vise-pinching noses, boring holes through tongues, and nailing ears to a log. In the 1870s the College of Surgeons looked back respectfully on the temerity and foresight of its founders—who, in the school’s genesis myth, dared to found an enclave of learning amid barbarism.
Youngest of the Scottish universities, Edinburgh had been teaching surgery and anatomy since early in the sixteenth century. The notion of a qualified professional physician, however, was relatively recent. Not until 1858, the year before Arthur’s birth, did the British medical establishment publish a register of accredited medical men. The profession had been advancing dramatically throughout the first half of the century, and all around Arthur were the recent fruits of research and experimentation. Shedding the cobwebs of the past, the largely progressive university was defining itself in opposition to more conservative Anglican institutions such as Oxford and Cambridge, where many influential faculty members still opposed such flourishing new ideas as Darwinian natural selection.
Like astronomy and geology and biology, medicine was growing in its understanding and in its technologies. Since their infancy in the seventeenth century, microscopes had become more advanced, enabling the detailed study of cellular structure, from tree xylem to human blood. The idea of inoculation—the introduction of smallpox virus into individuals who were not immune—had been explored earlier in China, Africa, and India, but not until 1796 did Englishman Edward Jenner effectively demonstrate the value and methods of inoculation in ways that the European medical community could no longer mock. In the 1840s a steel hypodermic syringe was first used to administer a subcutaneous injection—physicians having overcome two centuries of opposition to the method after early attempts had sometimes been fatal.
One of the great names in Edinburgh University’s recent history was James Young Simpson, who announced the anesthetic virtues of chloroform in 1847, sixteen years after its discovery. The new painkilling tool was quickly adopted in many areas. In the mid-1840s, dentist Horace Wells revived a notion originally proposed half a century earlier by the great chemist Humphrey Davy: the inhalation of nitrous oxide for pain relief. A colleague administered the so-called laughing gas to Wells while another colleague extracted one of his teeth without causing great pain. About the same time, a patient requesting to be mesmerized before surgery on his ulcerated tooth instead found himself inhaling sulfuric ether—one of many new weapons in the ancient struggle against pain.
Joseph Bell was not the only Edinburgh professor who inspired Arthur with the thrill and the modern relevance of medicine. For example, the renowned Charles Wyville Thomson, a professor of natural history in his mid-forties, taught zoology. In 1876 he returned from serving as Chief Scientist aboard HMS Challenger, having persuaded the Royal Society to fund adaptation of a naval vessel into a floating laboratory for study of the world’s barely known ocean life.
William Rutherford was the professor of physiology after serving as Fullerian Professor of Chemistry. He was short but broad-shouldered, and his enormous barrel chest projected a stentorian voice not softened by a beard that reminded Arthur of Assyrian bas-reliefs. He turned forty about the time Arthur met him. Having grown up in the tiny village of Ancrum Craig, in rural Roxburghshire on the southeastern coast of Scotland, and gone on to study in Vienna, Paris, and Berlin, Rutherford spoke with a curious accent. Dissecting a frog, he would exclaim, “Ach, these Jarman frags!” He had the presence and authority to cope with winter class sizes—250 students in his practical physiology course and twice as many in systematic physiology. He was famously adept at combining lecturing and demonstration. Often Rutherford began almost shouting his lecture from the hall, before reaching the classroom and his desk, not yet visible when he began, “There are valves in the veins . . .”
Arthur studied chemistry under Alexander Crum Brown, whose many contributions to science included a system of diagramming chemical compounds by denoting atoms with their symbols inside circles linked to the nucleus with a dashed line. Brown was known for his kindness and his unflappable manner. When a chemistry experiment that was supposed to result in a fire or explosion failed to do so, some men in the class were guaranteed to supply a shout of “Boom!” Brown would emerge from where he had taken refuge against the expected blast, calmly say, “Really, gentlemen!” and proceed with the class.
Henry Littlejohn was in his late forties when Arthur enrolled. Like Joe Bell, he was Edinburgh born and an alumnus of the university and of the Royal College of Surgeons. He had also studied at the Sorbonne. In 1854 the Royal College of Surgeons elected him a fellow and the Edinburgh Town Council appointed him Police Surgeon. The next year, he presented his first lecture in the School of Medicine and soon became known for his theatrical persona at the lectern. Gesturing dramatically, he presented with clarity and startling wit his perspective on topics ranging from the hygiene of slum dwellers to the drainage system of ancient Rome. Soon he was lecturing on forensic medicine. In 1861, following the collapse of a tenement that resulted in thirty-five deaths and countless injuries, the Edinburgh Town Council appointed Littlejohn as Edinburgh’s first Medical Officer of Health. His career partnered science and law enforcement.
Some professors influenced Arthur more by reputation than by presence. Robert Christison, for example, retired in 1877, but his legacy haunted the classrooms. He studied in Paris with the chemist Pierre Jean Robiquet and the Minorcan-born French toxicologist Mathieu J. B. Orfila, who was renowned for his studies of arsenic poisoning. Christison began teaching by following criminal investigations and trials in Scotland’s State Trials, informed by the best French texts. He first became known to the general public for his role in the 1828 trials of William Burke and William Hare—the notorious grave robbers who turned murderers to supply anatomists’ need for corpses at a time, prior to the Anatomy Act of 1832, when only executed criminals were available for dissection. Christison served as a medical witness in the trial; later, as medical advisor to the crown for Scotland, he formulated guidelines for the examination of corpses. Beginning on the side of prisoners in the Justiciary Court, sought by king’s counsel seeking loopholes for their clients, he was soon retained as a regular counsel across the aisle, on behalf of His Majesty’s courts.
Christison was legendary by the time Arthur entered his realm. Besides serving often as a forensic witness, he had extended and surpassed Orfila’s pioneer work in toxicology. And, like his colleague Joseph Bell, Christison had not hesitated to gamble his health—even his life—on research. After reading accounts of traditional “ordeal by poisoning” rituals among the natives of Old Calabar, a British colony along the Niger River on the southwestern coast of Africa, Christison experimented with the so-called Calabar ordeal-bean. In response to overwhelming evidence of the legume’s toxicity, including eyewitness accounts of grisly deaths, Christison prevailed upon his colleagues, including Syme, to cultivate it and supply him with fresh beans. He first tested the poison on animals, including a rabbit, every detail of whose death within five minutes he noted, and he recorded that slugs who nibbled the first fleshy cotyledons that pushed up through the soil from the vegetating bean were dead within twenty-four hours.
Despite noting that “this poison is one of great intensity of action,” Christison ingested some of it himself, and when he experienced few symptoms he increased the dosage. He compared the sensations’ progress with his previous experience of Indian hemp, opium, and morphia. “Being now quite satisfied that I had got hold of a very energetic poison,” he told the assembled members of the Royal Society of Edinburgh in 1855, “I took immediate means for getting quit of it, by swallowing the shaving water I had just been using, by which the stomach was effectually emptied.” Arthur paid close attention to such stories of scientific daring.
While he studied with these eminent men, most of Arthur’s energy was concentrated on lectures, textbooks, and medical articles. One of his most frequently consulted texts was The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod, an English physician who taught those topics at University College London, where he had also founded a museum of materia medica. Most physicians concocted and dispensed their own medications. It was essential to understand the therapeutic properties of an ever-growing arsenal, as well as to appreciate modern reassessments of traditional treatments that had emerged from sources such as medieval physick gardens. Thus Garrod had issued revised editions every few years since the acclaimed first in 1865.
Arthur bought the sixth edition in 1878. A fellow of the Royal Society, Garrod was renowned for promoting lithium to treat gout, because he discovered that it dissolved crystals of uric acid—elevated percentages of which he found in the urine of gout patients—and for naming and describing rheumatic arthritis. Arthur signed the flyleaf and began annotating the book throughout. He pored over the encyclopedic volume, underlining items and making notes on almost every page, summarizing sections in marginal notes. He noted that hemorrhoids ought to be treated with “Ointment of Galls and Opium” and included details about how to treat “a bad gonorrhoea.” He turned to the back and wrote on the endpapers his own abbreviated recipes for concocting medications. Directions for making opium included “Evaporate excess Colour between Calico.”
The back pages and other parts of the book wound up scribbled over with accounts of how patients might respond to particular drugs. Many of these notes Arthur composed in jaunty mnemonics and initialed ACD. He devoted fourteen rhyming lines, for example, to “Corrosive Sublimate as a Poison.” In his “Ode to Opium,” scribbled on an inside page, he rose to a gritty lyricism while still amusing himself:
I’ll tell you a most serious fact
That opium dries a mucous tract
And constipates and causes thirst
And stimulates the heart at first
And then allows its strength to fall
Relaxing the capillary wall.
The cerebrum is first affected,
Contracted pupils are detected
On tetanus you mustn’t bet
Secretions gone except the sweat
Lungs and sexuals don’t forget.