Wednesday, May 8, 2013

48. Disease

“Malingering is a subject upon which I have sometimes thought of writing a monograph.”
“The Adventure of the Dying Detective”

Earlier investigations into “The Resident Patient” and “The Devil’s Foot” have unearthed ways in which Conan Doyle’s medical expertise informed the canon. Specifically, diseases (particularly of a tropical or sub-tropical variety) appear or are mentioned in no less than ten times over the course of all of the novels and stories. But, perhaps no malady takes a more central role than the mysterious illness that befalls Holmes amidst the murder investigation of one Victor Savage of Rotherhithe in “The Adventure of the Dying Detective.” Adding to the mystery all the more is that the fatal illness is never named, and, in a careful ruse that runs throughout the story, Watson never gets close enough to examine his ailing friend. Even after the twist ending unmasks the culprit and once again begets hope for Holmes’s “recovery,” it appears that readers may never know the name of the mysterious illness. As with any good Sherlockian puzzle, speculations abounded for over 80 years until Dr. William A. Sodeman, Jr., a gastroenterologist at the Medical College of Ohio, offered a possible solution, published in the American Journal of Tropical Medicine and Hygiene. Dr Sodeman stated:

The illness had run a rapid course, and killed Savage in four days. Watson described Holmes as flushed, with the appearance of fever, with hard crusts around the lips, twitching, nervous hands, and a croaking voice. The pupils were dilated and there were cramps. In the course of his conversation with Watson, Holmes was delirious. Additional details included the delivery of the infection by inoculation…its selection as a lethal infection, and its origin in Sumatra. Watson, on visiting Smith, was shown a collection of deadly microbes cultured on gelatin. Smith was an amateur microbiologist. Most observers have opted for scrub typhus, typhoid, anthrax, or plague. All seem to me to be impossible and I offer melioidosis as the likely diagnosis.

Later, in a 2002 issue of the Journal of the Royal Society of Medicine, Dr. Setu K. Vora provided an excellent second opinion, noting that “evidence strongly supports the case for acute septicaemic melioidosis, as suggested by Sodeman.” And with that, expert medical opinion and a canny look through both medical history and the mind of Arthur Conan Doyle, “The Adventure of the Dying Detective” may now be a closed case. 

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