Several times in my life I have done utterly reckless things with so little motive that I have found it difficult to explain them to myself afterwards.
—ARTHUR CONAN DOYLE, MEMORIES AND ADVENTURES
Knowing the measure of his own ignorance, Arthur ran an advertisement for work during his time off from actual medical classes: “Third year’s student, desiring experience rather than remuneration, offers his services.” In the summer of 1878, he worked with Dr. Charles Sidney Richardson, who attended the poor in Sheffield, in Yorkshire, England. This position lasted only three weeks; later Arthur stated that he and Richardson parted “by mutual consent.” He wrote of Yorkshire, “No woods, little grass, spouting chimneys, slate-coloured streams, sloping mounds of coke and slag, topped by the great wheels and pumps of the mines.”
From dismal Sheffield he escaped to spend a few weeks with Doyle relatives in Maida Vale, amid the bustle and grandeur of London. He was so poor, and apparently so disappointed by the short-lived position with Richardson, that he seriously considered the offers of military recruiting sergeants who were set up in Trafalgar Square looking for burly, dejected young men. They offered the traditional earnest payment of one shilling. This exchange—a practice discontinued the following year—was equivalent to a handshake, and would have been followed by a visit to a magistrate and further payment for enlistment.
But Arthur resisted. He reminded himself that his mother had worked hard to provide him with a promising future. Still, he volunteered to serve as a medical dresser on ambulances in Turkey during the Russian War, but the latest in a long history of bloody conflicts was over before he could be shipped out.
The next answer to his advertisement arrived grandly postmarked Ruyton-of-the-Eleven-Towns, a village in Shropshire smaller than its name, where he worked with Dr. Henry Francis Elliot. Arthur didn’t mind laboring hard, even from dawn to midnight, but he found that he hated the unsuspected loneliness of serving as a medical assistant. After he wandered into his employer’s drawing room now and then, to speak to Mrs. Elliot where she sat with her baby, the doctor informed him sharply that he was defying custom: the assistant was to keep to himself and not socialize with the physician or his family. At one point Arthur wrote to his mother that he had worked three months without a chat with anyone, beyond an occasional word when he was invited into Elliot’s company for “a smoke.”
This temporary position was also memorable for the way it tested Arthur’s nerve. During a celebration at a historic site, a cannon’s fuse was lit. Instead of firing, however, it exploded, raining shrapnel onto a bystander. A frantic messenger raced to Elliot’s house, only to return with his inexperienced young assistant instead. Arthur found himself gazing at a lump of iron projecting from the head of a man who lay in bed. He had to decide immediately. He grasped the projecting iron near the man’s hair and tugged it out. When he did so, below the blood he could see clean white bone, which told him that the iron had not reached the man’s brain. He stitched the wound. Arthur’s decisive response inspired new confidence in himself—and, he noted, in those around him.
The next year Arthur’s summer position with Dr. Reginald Hoare in England’s Midlands was paid—a token £2 per month. Arthur was still raw, but learning as quickly as he could. He liked Hoare. His luxuriant beard and country lad’s shoulders belied a canny professional who could turn three-shilling treatments and one-shilling prescriptions, eked from the paupers of Aston in central Birmingham, into an annual income of £3,000.
Doing his part, however, kept Arthur scurrying day and night. Some evenings, already exhausted, he would be handed a scribbled list of as many as a hundred medicaments to weigh, measure, stir, and package in their boxes and phials. Try as he might, he made mistakes. He was known, for example, to occasionally prepare detailed directions for a patient’s pill box that, when opened, proved empty.
* * *
During his busy first few weeks with Dr. Hoare in Birmingham in June 1879, Arthur risked his life in a dangerous experiment. Sometime earlier, while suffering from neuralgia, he had given himself several doses of an alkaloid pain depressant called gelseminum. It was derived from the plant Gelseminum (later Gelsemium) sempervirens, a twining yellow-blossomed vine native to tropical and subtropical American woodlands, called variously evening trumpet flower or yellow jasmine. Many parts of the plant were saturated with toxic alkaloids of the strychnine family. Arthur’s pain continued unabated at first, so he exceeded the prescribed dosage—and observed no ill effects.
Alfred Baring Garrod addressed gelseminum at length in his Materia Medica. Under the heading Tinctura Gelsemii in his copy, Arthur underlined key parts of Garrod’s description: “It has been employed in various forms of neuralgia, rheumatism, and muscular spasm, as a sedative . . . Death results from apnoea, due to paralysis of the respiratory muscles.” To the ailments it would treat, Arthur scrawled the marginal addendum “also for Chorea and inflammation.”
Underneath these notes he wrote “Fraser” and underlined it. Formerly Robert Christison’s assistant, Thomas Richard Fraser assumed the position of professor of materia medica upon his mentor’s retirement in 1877. Like Christison, Fraser was known for his adventurous and personal approach to pharmacology. It had been launched with his gold-medal-winning thesis on the ordeal-bean of Calabar, a further examination of the poison with which Christison had experimented. By Arthur’s time, Fraser was a prominent figure. The year he became professor of materia medica, he was invited to join the Royal Society, and in 1878 he became dean of the medical faculty. Arthur studied with him during his second year.
“Though much used in America,” Garrod said of gelseminum, “it has hitherto been little investigated in this country.” In the United States, physicians often prescribed gelseminum for pain accompanying a variety of ailments, including influenza, ague, and menstrual cramps. Gelseminum was less accepted throughout Europe—and not approved for the British pharmacopoeia—because its confirmed dangers outweighed its possible virtues. Arthur must have known that no medical professional doubted its threat. In an 1832 article, the U.S. physician William Tully was already warning of the dangers of exceeding recommended dosages: “If a quantity larger than is barely necessary . . . is administered, it produces . . . ultimately even stupor, coma, and death.”
During the late 1870s, several medical scientists devoted extensive research to gelseminum. For example, The Lancet had been publishing a series of well-researched articles on it by Sydney Ringer, a professor of therapeutics at Garrod’s own University College, and William Murrell, a demonstrator of physiology at the same institution. Founded by surgeon and reformer Thomas Wakley in 1823, The Lancet had become an indispensable organ of British medicine, and as an ambitious student Arthur would have been expected to follow each issue closely.
Thus he could not have missed the series by Ringer and Murrell. Reporting research on frogs, cats, rabbits, guinea pigs, and a poodle, they concluded, “In all these experiments, death appears to have resulted from asphyxia.” In the spring of 1876, Ringer and Murrell reported administering gelseminum to six human beings on seventeen occasions, “in doses sufficient to produce decided toxic effects.” Patients described a predictable succession of symptoms: brow pain, giddiness, eyeball pain, dimming of sight, double vision, drooping eyelids, and restricted movement of the eyeball. “The patient next complains of weakness of the legs, and we have never pushed the drug beyond the production of this symptom.” They analyzed the effect on respiration and circulation, body temperature, mental faculties, and other phenomena. A physician reported that in 1866 he took gelseminum “through mistake,” reporting that his most frightening symptom was almost total blindness for several hours.
In June 1878 The Lancet concluded its gelseminum series with two articles on it “as a toxicological agent.” Because of the drug’s unpopularity in Britain, most of the material for this survey derived from U.S. sources. Standards there were so lax that one U.S. physician ordered a patient to take a dose of gelseminum tincture and declared that if she held up a finger and saw only one—thus not yet experiencing double vision—she could risk another dose. Physicians reported many deaths—a pregnant woman who overdosed on gelseminum, a woman who died after receiving it as a painkiller following an abortion, and sailors who plundered a barrel of what they mistakenly thought to be alcohol but was actually tincture of gelseminum. One doctor had witnessed the deaths of three children from overdose.
Yet Arthur boldly imitated the dangerous exploits of Robert Christison and Thomas Fraser with the calabar bean. Tincture of gelseminum was created by mixing dried gelseminum roots and rhizomes, which were available as gelseminum powder, with standard percentages of alcohol and water. Arthur measured his dosage of the milky yellow fluid in minims. The minim had been introduced in 1809 as a more precise unit than a drop, formerly the standard measure. Apothecaries had long known that viscosity and other factors caused the size of a drop to vary, so finally they standardized a minim as equaling 1/60th of a fluid drachm or 1/480th of a fluid ounce. Arthur employed a graduated glass pipette called a minimometer to measure out his self-poisoning. He administered gelseminum to himself in increasing dosages and monitored its effects, in order to determine which amounts might truly constitute an overdose—and what his symptoms might be during the process. During this time he denied himself tobacco because he feared it might skew his results.
Rather than increase his dosage in increments, he quickly escalated it as he took gelseminum at roughly the same hour each day. He started on a Monday morning at 10:30 by swallowing forty minims of the bitter liquid with no apparent effect, and on Tuesday sixty minims also seemed harmless. Wednesday’s dose was ninety—already exceeding the limit established as fatal. Twenty minutes after he took it, Arthur rose from his chair and found himself giddy. His limbs felt weak. He checked his pulse and found it thready but not frightening. Soon the symptoms faded away.
He soldiered on. Thursday morning found him swallowing 120 minims. Soon he felt giddy again, but not as severely as on Wednesday. He felt almost normal until he walked outdoors at about one o’clock, when slowly he realized that he was having difficulty seeing distant scenes. To focus his eyes, he had to concentrate and squint. Nonetheless, on Friday he administered to himself 150 minims—double the supposedly fatal dosage. He found that at this advanced level his giddiness all but disappeared. In its place, however, he gradually developed barely surmountable lethargy and an agonizing frontal headache. Severe diarrhea kept him running to the chamber pot—which surely prevented his being available to assist Dr. Hoare.
Despite these frightening symptoms, despite his body’s many ways of warning that it was greatly agitated by the poison, the weekend found Arthur raising his bet against fate. On both Saturday and Sunday morning he took 200 minims of gelseminum—over a third of an ounce. The headache returned with a vengeance. Diarrhea became so constant and severe on Sunday that he resolved to end the experiment. Despite feeling overwhelmingly depressed, despite a hammering headache, he made a note of the dosage and counted his pulse. It was weak but steady.
Against the odds, Arthur survived. He wrote up his experiment and sent it to the British Medical Journal. He carefully described his symptoms and summarized his conclusions. “A healthy adult may take as much as 90 minims with perfect immunity,” he declared flatly, failing to mention that he was a robust young man whose body was used to being pushed to its limits in boxing, hiking, and other rigorous activities. “I feel convinced that I could have taken as much as half an ounce of the tincture,” he remarked, “had it not been for the extreme diarrhœa it brought on.”
His account appeared as a letter to the editor in the issue of September 20, 1879, titled simply “Gelseminum as a Poison.” He signed it “A.C.D.,” and included Dr. Hoare’s address: Clifton House, Aston Road, Birmingham. It was his first publication about medicine. In its bodily risk, it was worthy of Christison’s and Fraser’s example. Whether a form of bravado or despair, of professional hero worship or personal self-torture, this antic verged on the suicidal—and wound up a public statement of reckless disregard for danger that would soon find other expressions.