by Dr. Otto Wurl, M. D.
Throughout the Sherlockian Canon, Dr. Watson refers on a number of occasions to medical conditions which are of more than passing interest for the reader. Especially noteworthy was Dr. Watson's immediate recognition and diagnosis of the thoracic aneurism presented by Jefferson Hope at the final encounter in the police station less than 24 hours prior to Hope's death. You will recall the circumstances which occurred when Hope requested permission to tell his story to Holmes, Gregson, Lestrade, Dr. Watson and the police inspector who recorded Hope's statement:
"I've got a good deal to say," our prisoner said slowly. "I want to tell you gentlemen all about it."
"Hadn't you better reserve that for your trial?" asked the inspector.
"I may never be tried," he answered. "You needn't look startled. It isn't suicide I am thinking of. Are you a doctor?" He turned his fierce dark eyes upon me as he asked this last question.
"Yes, I am," I answered. "Then put your hand here," he said, with a smile, motioning with his manacled wrists toward his chest.
I did so: and became at once conscious of an extraordinary throbbing and commotion which was going on inside. The walls of his chest seemed to thrill and quiver as a frail building would do inside when some powerful engine was at work. In the silence of the room I could hear a dull humming and buzzing noise which proceeded from the same source.
"Why," I cried, "You have an aortic aneurism!"
Perhaps it would be well at this time to review briefly the characteristics of aortic aneurysms which permitted Dr. Watson to make this diagnosis with prompt and unerring precision. Dorland's Medical Dictionary defines aneurism as "a sac formed by the dilatation of the walls of an artery or of a vein and filled with blood. The chief symptoms of arterial aneurysms are the formation of a pulsating tumor, a peculiar bruit heard over the swelling, and pressure symptoms...."
Regarding the cause of thoracic aneurysms, the late Sir William Osler, fellow of the Royal College of Physicians and Regius Professor of Medicine, Oxford University wrote in his textbook, The Principles and Practice of Medicine initially published in 1892, the following: "While the ordinary arteriosclerosis may lead to aneurism, the great majority of the cases result from the aortitis associated with syphilis, which leads to loss of elasticity and local rupture the causes which favor arteriosclerosis prevail in aortic aneurism, particularly syphilis and overwork. The greatest danger probably is in strong muscular men with commencing degenerative processes in the arteries, the result of aortitis, who during sudden muscular exertion are liable to lacerate the coats "
Regarding the incidence of aneurysms, Osler quotes the experience of St. Bartholomew's Hospital in London where 631 cases of aneurism were observed over a 30 year period, of which number there were 468 cases of aortic aneurism. It should be recalled that Dr. Watson had his hospital training at Bart's where young Stamford had been a dresser under him.
It is no wonder Dr. Watson, with his medical training at the University of London and clinical experience at Bart's, was so competent in the diagnosis of thoracic aneurism. Perhaps his diagnostic acumen was enhanced by contacts with Surgeon-Major William S. Oliver of the army medical department who wrote a letter to the medical journal Lancet on September 13, 1878, the year Dr. Watson received his doctor of medicine degree, describing a physical sign for the diagnosis of thoracic aneurism. This sign, known to every medical student as Oliver's sign or the tracheal tug, was evidently not elicited by Dr. Watson in his brief examination of Hope since his palpation of the chest wall overlying the aneurism was conclusive evidence of its presence. It may be that Dr. Watson met Oliver in India where the latter served with distinction in the army medical department of Her Majesty's forces.
As to the prognosis of Jefferson Hope's aneurism, Dr. Watson's keen awareness of this aspect of the condition permitted him to warn Gregson, Lestrade, and the police inspector of Hope's imminent death. You will recall the dialogue:
The inspector and the two detectives had a hurried discussion as to the advisability of allowing him to tell his story.
"Do you consider, doctor, that there is immediate danger?" the former asked.
"Most certainly there is," I answered.'
Events proved Dr. Watson's prognosis was correct when Jefferson Hope was found dead the following morning on the floor of his cell, "with a placid smile upon his face, as though he had been able in his dying moments to look back upon a useful life, and on work well done."
It is not appropriate at this time to consider the "usefulness" of Jefferson Hope's life or his "work well done", or the ruggedness of his life in Utah, or his travels throughout the United States and Europe, or to reflect upon those whose paths he may have crossed in his relentless search for Enoch Drebber and Joseph Stangerson to avenge the wrongs of these men. It is sufficient only to note how skillfully and accurately Dr. Watson perceived the presence of the aneurism and prognosticated its lethal course with the knowledge, insight, and acumen befitting his close association with the Master.