East Wind Coming
Page 18
Helen Simpson3 also considered that Watson ‘Took the degree of MD of London, an extremely difficult one to obtain.’ (Of course Simpson does not deny Watson’s claim to MD; indeed, if she is correct, he was well qualified rather than the reverse.)
However, David Young’s opinion is ‘an MD was not given away in 1878 but it would be wrong to bestow upon it the status and level of difficulty that it has today.’ 4
There are thus two schools of thought as to the sheer difficulty of Watson, or anyone else, being able to qualify as an MD. In an attempt to judge the level of difficulty, HY examined the titles and qualifications of all the physicians and surgeons in the hospitals in London in 1888, as listed in Dickens’s Dictionary of London, 1888. (5; and see Tables I and II.)
There were 372 physicians, of whom 225 (60%) had an MD, some with other qualifications, and 124 (33%) had ‘Dr,’ again some with other qualifications. The total with either ‘Dr’ or MD is thus 93%; it is possible that some of those styled ‘Dr’ did not in fact possess an MD, but that ‘Dr’ was a courtesy title. However, the Dictionary is fairly detailed, so it seems unlikely that ‘Dr’ was a courtesy title in every case. Even if it were, a majority of physicians definitely had an MD.
There were 348 surgeons, including anaesthetists, oculists and surgical registrars. Of these, 157 (45%) had no style or title, 122 (35%) had FRCS or FRS, sometimes with other degrees, etc; 25 (7%) had MRCS; 12 (3%) had MB or MS or BS; 6 (2%) had ‘Dr’; and 27 (8%) had MD. (And again, in all cases some had other degrees, etc.) The total with either ‘Dr’ or MD was thus 33 (10%).
And if we exclude those whose titles and degrees are not specifically listed, the total with an MD is 14%, and with ‘Dr’ or an MD 17%. So where the title or degree is listed, nearly one in five surgeons is ‘Dr’ or an MD.
In an attempt to ensure that the figures were as representative as possible, JH submitted the 1881 listing to a similar, though somewhat less rigorous, analysis, and found that 69% of physicians and 11% of surgeons had an MD.(a)
These figures show that taking an MD was quite common in the Victorian era for physicians, and it was by no means uncommon for surgeons. Young4 pointed out that ‘whilst it is relatively uncommon to find British General Practitioners with an MD today, this was not the case in the 19th century.’ The routes to an MD were the same in London as Scotland, ie two years hospital experience and a thesis, or five years general practice and thesis or dissertation. Sir Arthur Conan Doyle graduated from Edinburgh with an MB in 1881, and after general practice for five years he took an MD from Edinburgh with ‘An Essay upon the Vasomotor Changes in Tabes Dorsalis.’6 The Literary Agent could gain an MD, so why not our Watson? There were only 4% of physicians and 3% of surgeons who worked with an MB. Contrary to the opinion of Ikoma and others, doctors with an MB were scarcer than those with an MD.
Holmes’s statement in ‘The Dying Detective’ about Watson’s ‘mediocre qualifications’ was intended to keep Watson at arm’s length, or further, and not to be taken literally; Holmes also says, in The Hound of the Baskervilles:
‘Come, come, we are not so far wrong after all. . . And now, Dr James Mortimer - ‘
‘Mister, sir, Mister, a humble MRCS.’
‘And a man of precise mind, evidently.’
‘A dabbler in science, Mr Holmes. . . I presume that it is Mr Sherlock Holmes whom I am addressing and not - ‘
‘No, this is my friend Dr Watson.’
James Mortimer honestly refused to be called by the courtesy title ‘Dr,’ but at the same time Watson as called such by Holmes, almost in the same breath as Holmes’s implied praise for a ‘man of precise mind,’ and nobody objected to ‘Dr Watson.’ If Watson’s title ‘Dr’ were merely a courtesy title, he would surely have been arrogant and pompous not to do what Mortimer did and complain? And that does not match our image of Watson as an honest man.
There is an apocryphal reference to Watson’s title in ‘The Field Bazaar,’ which might on the face of things tend to support Kobayashi and Higashiyama’s point of view. Holmes says, ‘I gathered from the use of the word ‘Doctor’ upon the address, to which, as a Bachelor of Medicine, you have no legal claim. . .’ William Baring-Gould referred to this when he said that ‘Doubts that Watson was, in fact, a Doctor of Medicine have been cast by many commentators - not the least of them Conan Doyle’ in ‘The Field Bazaar.’7 However, John Hall wrote: ‘Even if Watson had graduated with an MB from Edinburgh. . . then if the Edinburgh authorities were so scrupulous as to titles [as Holmes is suggesting in the story] they would surely be inclined to style him ‘Dr’ on account of the later (London) degree. . . the entire episode may safely be dismissed a invention.’8 (And moreover Young, in the article already noted4, makes the point that the London university regulations required that candidates for an MD should have taken their first medical degrees at London, further reinforcing the apocryphal nature of ‘The Field Bazaar.’) It is rather odd that Baring-Gould should ignore the rule that the Canon is the first, and perhaps the only, source; ‘The Field Bazaar’ is interesting, but we cannot legitimately regard it as evidence of anything.
Hall also discussed Watson’s experience at Bart’s. ‘Why did Watson, after having been a house-surgeon(b) at some point, then take the medical degree, MD, instead of a Master of Surgery, MCh? This takes us into the realms of speculation rather than reasoning, but there are surely enough acceptable reasons for us not to worry about it too much. Perhaps he had originally intended to specialise in surgery, but found medicine more congenial - he may have preferred his patients vertical rather than horizontal. Or perhaps he realised that an army doctor would need to be master of all trades, and thus took in surgery almost in passing, as it were. In the latter event, it would say much about his medical abilities, which are sometimes underrated.’9
This assumes that it was an uncommon thing for a house-surgeon to take an MD. However, as we have seen, this is incorrect; one in two Victorian surgeons had ‘Dr’ or MD. Even if Watson had originally intended to specialise in surgery, he may well have taken and MD. In 1888 there were 12 surgeons with MD alone after their names, but they may well also have had FRCS or MRCS, etc, and so may Watson! The latter titles may well have been omitted from the title page of A Study in Scarlet as it was not a formal medical paper. Even in our Table II, every surgeon ought to have BCh or similar, but not all of them claim this. Some write FRCS, some MB, FRCS, etc. Conan Doyle himself was Arthur Conan Doyle, MB, CM, MD, but he frequently wrote ‘Arthur Conan Doyle, MD.’ His own fashion of writing his qualifications changed with time:
A Conan Doyle, MB, CM (The Lancet, November, 1884)
A Conan Doyle, MD (Portsmouth Evening News, May, 1886)
A Conan Doyle, MD (Light, July, 1887)
A Conan Doyle, MD, CM (Portsmouth Evening Mail, July, 1887)
A Conan Doyle, MD (Daily Telegraph, November, 1890)
A Conan Doyle, MD (BMJ, July, 1900)
Arthur Conan Doyle, MD (Edin), LLD (Journal of the Society for Psychical Research, March, 1930) 10
Conan Doyle took his MD in 1885, and this was added to his MB, CM; but Conan Doyle seldom wrote his degrees in full, even when writing to the BMJ. (The ‘LLD’ noted in 1930 was ‘an honorary doctorate. . . from his Alma Mater’11.) Watson must have had an MB from London, in order to take the degree of MD, as noted by Young4. Watson would also take a first degree in surgery, as a matter of course, and he may very well have had for example, MRCS as well, but simply not recorded the fact, any more than Conan Doyle listed all his entitlements.
Let us now consider Watson’s army career in terms of ‘real life’ army men. Our good friend Major John Whitehouse kindly sent us some photocopies of publications of the Army Medical Corps, and these give the names of some army doctors. The author of ‘Personal Recollections of the Afghan Campaigns of 1878-79-80. . . etc’ is ‘Surgeon-General GJH Evatt, MD’12, while in
another paper we find ‘Surgeon-General T Crawford, MD, Principal Medical Officer, Her Majesty’s Forces in Bengal.’13 These two men fought in the second Afghan War in which Watson was injured, and both were surgeons with an MD. There is clearly nothing out of the ordinary in Watson’s also being an army surgeon with an MD. As Young pointed out, the reason why Watson chose to join the Army Medical Department was just that he ‘did not have the capital to buy into a good practice, and life as an assistant to another doctor was likely to be boring and not very renumerative.’4
Ikoma2 also thinks that Watson could not have practised surgery at all, as he was not FRCS. Ikoma concluded that Watson was not a surgeon but a general practitioner. Again, we can look at examples from real life. The following is a fairly typical career of a surgeon who studied in London. He was Takagi Kanehiro (1849-1920), the first commander of the Japanese Royal Navy Medical Corps. Takagi was a son of a samurai, and studied medicine privately in Japan under an English doctor. Takagi was sent to Britain by the Japanese Government to study the latest medical techniques for the Royal (Japanese) Navy. He was a distinguished student, and received many awards.
1875, Sept: Entered St Thomas Hospital
1877: Clinical Clerk
1878, Jan: Secretary of Obstetrics
April: MRCS
June: LRCP (Licentiate of the Royal College of Physicians); house physician
1879: house surgeon
1880, May: FRCS, returned to Japan
Conan Doyle’s own career may be summarised:
1876, Oct: Entered Edinburgh Medical School
1878, summer: Student Assistant to Dr Richardson, Sheffield, and Dr Elliot, Shropshire
1879, summer: Student Assistant to Dr Hoarse, Birmingham
1880: Ship’s Surgeon on Arctic Whaler Hope for seven months
1880: Student Assistant to Dr Hoare, Birmingham
1881, August: Graduated MB and CM
1885, July: MD, Edinburgh14
Ikoma wrote that FRCS was given to only a few outstanding surgeons, and only those who were FRCS or FRCP could be consultants. As we have seen, only 35% of hospital surgeons were FRCS in 1888 (43% in 1881). As for the ‘outstanding’ aspects, Takagi graduated FRCS a mere two years after his MRCS and LRCP, and only one year after his appointment as house surgeon. True, Takagi was an indeed an outstanding man, but Conan Doyle’s own career is not so very far behind. One of the important rulings of the General Medical Council was that ‘medical education should not be less than your years.’14 If Takagi had studied at London he would have graduated MB in 1879, the year he became house surgeon and Conan Doyle’s MB, CM was caused by ‘time taken out to earn money.’10 Conan Doyle worked as a student assistant in the summer holidays, and was a ship’s surgeon on the Arctic whaler Hope for seven months in 1880, a year before he graduated.15 Hall thought that Watson studied eight years at London16, and thus it is perfectly possible for him to have taken his MD after taking, say, FRCS. (Although Hall’s ‘eight years’ is based on the classic view that Watson took his MD by purely hospital work; Hall is now inclined to follow David Young and credit Watson with four or five years for the first degree, and five in general practice thereafter. This, however, does not alter the general argument here.)
Again, we could argue from Conan Doyle’s own surgical experience. Although the sign on his door read, ‘Dr Conan Doyle, Physician and Surgeon,’ he was a general practitioner.17 And we know that Conan Doyle performed some simple operations; he wrote in his biography: ‘I went up country once, and operated upon an old fellow’s nose which had contracted cancer through his holding the bowl of a short clay pipe immediately beneath it. I left him with an aristocratic, not to say supercilious, organ, which was the wonder of the village and might have been the foundation of my fame.’18
Rodin and Key wrote: ‘This account indicates a good knowledge of cancer causation and surprising surgical skills for a recent graduate.’19 Just as his sign indicated, Conan Doyle worked as a surgeon. Ikoma makes the point that there are no accounts of Watson’s performing any operations in the Canon, but the stories are detective, not medical, tales. Watson was an army surgeon, faced with a blood thirsty enemy in Afghanistan, and it is legitimate to enquire whether his experience was really limited to ladling out cough syrup, or dispensing brandy for ladies who had swooned with the heat. It is surely clear that Watson would have performed surgical operations where these were needed. If David Young’s theory that Watson gained his MD by five years in general practice is correct (and there are good reasons for thinking it is, as it enables us to explain some otherwise odd episodes in Watson’s life, eg his visiting Australia) then commonsense alone suggests that the probability that Watson had some surgical experience becomes even greater, particularly if we do locate some part of his eventful like in the wilds of Australia, say, where there would be little other medical aid available.
In any event, we know that Watson spent some time as a house surgeon at Bart’s, that is unless we disregard that part of the Canon as well. Note also that whether Watson was a house surgeon as part of his hospital studies for the MD, or just working on a temporary basis as Young suggests, still the authorities at Bart’s chose Watson from however many applicants there may have been; scarcely an indication of mediocre qualifications or experience there!
Whether we look at the evidence of the Canon itself, or at the statistics of Victorian medical qualifications, or at the life of his creator, the answer is the same. It is safe to say that Watson as an army surgeon and general practitioner with and MD and other qualifications, though we can only speculate as to these. The Canon is right, as always.
(a) The figures of course reflect the fact that these men (and a few women) were on the hospital staff; it would be wrong to imply or infer that the proportions were necessarily reflected amongst general practitioners. However, the staff listed include relatively junior registrars, etc, so the figures may reasonably be regarded as a fair cross-section. (And it may well have been that the juniors with MRCS or MB were working towards Fellowship and MD respectively!
The fall in the % with MD between 1881 and 1888 is intriguing; it is tempting to see it as reflecting an increase in the examiner’s standards, but this is almost too facile.
(b) There seems no dispute on this point, although the ‘classic’ view has been that it was part of Watson’s two (or more) years hospital work; while Young 4 considers that it may have been merely a short-term post as part of his (five years) general practice.
TABLE I; Physicians at London hospitals, 1888
No qualifications noted
4
4
1%
MA, MD, MRCP
1
225
60%
KCB, MD, FRCP, DCL, FRS
1
MD, KCB
1
MD
140
MD, MRCS
4
MD, MA
3
MD, FRS
11
MD, MRCP
12
AB, MD, MRCP
1
BA, MD
1
MD, MRCP, DCL
1
MD, FRCP
33
MD, KCSI
1
MD, KCMG
1
MD, FRCP, FRS
8
MD, FRCS
2
MD, BS
2
MD, CB
1
MD, LRCP
1
Dr
113
124
33%
Dr, MRCP
3
Dr. FRCP
4
Dr. FRS
4
MB
11
15
4%
MB, MRCP
1