Conan Doyle, self-dosing, and Dr Reginald Hoare of Aston, Birmingham

I've been reading and thinking about ACD's medical training, mainly because I'm re-reading Stark Munro Letters in great detail for the first time.

Personally, I struggle to understand Doyle's exact timelines for his medical apprencticeships/assistantships, and how he accomplished his academic requirements (coursework and practical work). 'Memories & Adventures' is quite informative (and entertaining), and from it we learn about Doyle's two ship-board expeditions (Arctic and West Africa), and three experiences with doctors:

• Summer of '78: 'Dr. Richardson, running a low-class practice in the poorer quarters of Sheffield'
• Four months: 'Dr. Elliot living in a townlet in Shropshire which rejoiced in the extraordinary name of “Ruyton-of-the-eleven-towns.”'
• 1879: Dr. Hoare, a well-known Birmingham doctor, who had a five-horse City practice.
• Oct 1881 - Jan 1882 on board 'Mayumba' to Africa as ship's surgeon 
• May 1882: Brief stint with Budd before setting up independently in Southsea 

Let's look at Dr. Hoare, and Doyle's enduring connection to the area.

"After a winter’s work at the University my next assistantship was a real money-making proposition to the extent of some two pounds a month. This was with Dr. Hoare, a well-known Birmingham doctor, who had a five-horse City practice, and every working doctor, before the days of motors, would realize that this meant going from morning to night. He earned some three thousand a year, which takes some doing, when it is collected from 3s. 6d. visits and 1s. 6d. bottles of medicine, among the very poorest classes of Aston. Hoare was a fine fellow, stout, square, red-faced, bushy-whiskered and dark-eyed. His wife was also a very kindly and gifted woman, and my position in the house was soon rather that of a son than of an assistant. The work, however, was hard and incessant, and the pay very small. I had long lists of prescriptions to make up every day, for we dispensed our own medicine, and one hundred bottles of an evening were not unknown. On the whole I made few mistakes, though I have been known to send out ointment and pill boxes with elaborate directions on the lid and nothing inside. I had my own visiting list, also, the poorest or the most convalescent, and I saw a great deal, for better or worse, of very low life. Twice I returned to this Birmingham practice and always my relations with the family became closer. At my second visit my knowledge had greatly extended and I did midwifery cases, and the more severe cases in general practice as well as all the dispensing. I had no time to spend any money and it was as well, for every shilling was needed at home."

While Doyle was staying with Hoare, he published an article titled “Gelseminum as a Poison” in the British Medical Journal (20 Sep 1879, page 483, see a copy in  ACD Encyclopedia, not indexed in Pubmed). The article is authored 'A.C.D. Clifton House, Aston Road, Birmingham.' In the article, Doyle states that 'several years ago' (in his teens!) he had suffered from 'a persistent neuralgia' and taken gelseminum - a plant extract of yellow jasmine. Doyle states that he "recently had an opportunity of experimenting with a quantity of fresh tincture" - presumably in the dispensary he now worked at each evening. Having Dr. Hoare nearby while conducting self-experimentation would have been useful - if indeed Doyle shared his work with his employer.

In M&A Doyle mentions that "Twice I returned to this Birmingham practice and always my relations with the family became closer. At my second visit my knowledge had greatly extended and I did midwifery cases, and the more severe cases in general practice as well as all the dispensing." When were these two visits exactly?

Well, one was around March 1882, as Doyle yet again published a medical article, this time a case study. The article titled 'Notes on a Case of Leucocythaemia' appeared in The Lancet (25 Mar 1882, page 490, see a copy in  ACD Encyclopedia, not indexed in Pubmed). The name has a typo in the name, and was sent from 'Aston'. In the article, Doyle describes that case of a patient presenting with what we now call leukemia (a cancer of the bone marrow resulting in an over-production of aberrant white blood cells). A 29-year-old presented with a massively enlarged spleen that had developed over a few weeks, and Doyle examined his blood under a microscope finding white blood cells vastly over-produced. What greatly interests me is that Doyle described a positive treatment with chemotherapy - 'arsenic in large doses, in combination with the iodide and chlorate of potash'. Doyle's report highlighted that the patient had previously had malaria (ague), but I think his comment that 'The tumour has already diminished in size, and some of the more distressing secondary symptoms have been alleviated' is infinitely more significant. Arsenic (as arsenic trioxide) is front-line therapy to treat a specific form of leukemia (APL) but only approved in 2000 by the FDA. The first reports of using arsenic to treat leukemia were published in the US in 1878, so this represents a remarkable early use by Doyle (and Hoare). 

As medical articles these have been analyzed. My interest in these medical articles is that they both tie Doyle to Dr. Hoare, and therefore provide two precise dates for times when Doyle was serving. Did Dr. Hoare encourage Doyle to publish his medical reports? Or was it simply that bustling Birmingham and a busy practice under Dr. Hoare presented a great chance for medical observations worth sharing with his peers.

Apart from the two reports from Birmingham, Doyle only published one other medical case report (titled ''The Remote Effects of Gout), from Southsea on 24 Nov 1884). Doyle did publish some descriptive articles based on his experience in the Boer War (where he was again a practicing physician) but not case observations.

There is of course Doyle's medical thesis. It was titled 'An essay upon vasomotor changes in tabes dorsalis' (i.e. the neurologic manifestation of late-stage syphilus) and written around April 1885 at Bush Villas, Southsea. Towards the end of the thesis, Doyle presents a short discussion on possible treatment options, and specifically nitroglycerine: 'Nitroglycerin however in a one per cent solution is a most handy and convenient preparation' (page 81 of the thesis, digitized at the ACD Encyclopedia). But we again find Doyle, a young man stating 'The dose, beginning with one drops may be safely encreased to fifteen or twenty, a congestive headache being the first sign of an overdose. I have myself taken as many as forty minim's of Murrell's solution without inconvenience'. 

Does a young man aged twenty five require nitroglycerine, or is this again Doyle exploring dose windows to study effects? Two of four papers by Doyle from the 1880s refer to self-dosing. It certainly appears Doyle self-administered (prescribed), but it is difficult to determine if this was always because of a malady, or instead out of curiosity alone. 

This post was meant to be about Dr. Hoare - so that'll have to be a follow-up post!