The Scots surgeon who played a role in the creation of Sherlock Holmes

I mentioned in passing in my series on medical sciences that the Holmes character was inspired by a doctor and lecturer, Joseph Bell.

He taught Doyle at Edinburgh University’s Medical School in the 1870s and considered him to be the best student he ever had. Bell employed Doyle as his clerk so that the future novelist was able to closely observe the master at work.

A reader wrote to ask me if I knew any more about Bell and asked if I prove he was the main inspiration for Holmes. Happy to oblige …

I have written about Bell before, most recently in connection with the not-proven verdict in the infamous Ardlamont Mystery of 1893-4 for which Bell was an expert witness, but am happy to expand on the fascinating subject that he is.

First of all, however, my proof that Bell inspired Holmes and it comes from Doyle himself. In May 1892, after the initial success of the Sherlock Homes novels, Doyle wrote to Bell saying: “It is most certainly to you that I owe Sherlock Holmes, and though in the stories I have the advantage of being able to place him in all sorts of dramatic positions, I do not think that his analytical work is in the least an exaggeration of some effects which I have seen you produce in the outpatient ward.”

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He followed that up with an interview in The Strand magazine just a few months later: “I was clerk in Mr Bell’s ward. A clerk’s duties are to note down all the patients to be seen, and muster them together.

“Often I would have 70 or 80. When everything was ready, I would show them in to Mr Bell, who would have the students gathered round him. His intuitive powers were simply marvellous.”

Further proof comes again from Doyle himself. In his autobiography Memories And Adventures, published in 1923, the author wrote: “The most notable of the characters whom I met was one Joseph Bell, surgeon at the Edinburgh Infirmary.

“Bell was a very remarkable man in body and mind. He was thin, wiry, dark, with a high-nosed acute face, penetrating grey eyes, angular shoulders, and a jerky way of walking. His voice was high and discordant. He was a very skilful surgeon but his strong point was diagnosis, not only of disease but also of occupation and character.

“For some reason which I have never understood, he singled me out from the drove of students who frequented his wards and made me his outpatient clerk, which meant that I had to array his outpatients, make simple notes of their cases, and then show them in, one by one, to the large room in which Bell sat in state surrounded by his dressers and students.

“I had ample chance of studying his methods and of noticing that he often learned more of the patient by a few quick glances than I had done by my questions. Occasionally the results were very dramatic, though there were times when he blundered.

In one of his best cases he said to a civilian patient:

‘Well, my man, you’ve served in the army.’

‘Aye, sir.’

‘Not long discharged?’

‘No, sir.’

‘A Highland regiment?

‘Aye, sir.’

‘A non-com officer?’

‘Aye, sir.’

‘Stationed at Barbados?’

‘Aye, sir.’

“‘You see, gentlemen,’ he would explain, ‘the man was a respectful man but did not remove his hat. They do not in the army, but he would have learned civilian ways had he been long discharged. He has an air of authority and he is obviously Scottish. As to Barbados, his complaint is elephantiasis, which is West Indian and not British, and the Scottish regiments are at present in that particular island’.

To his audience of Watsons, it all seemed very miraculous until it was explained, and then it became simple enough. It is no wonder that after the study of such a character I used and amplified his methods when in later life I tried to build up a scientific detective who solved cases on his own merits and not through the folly of the criminal.

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“Bell took a keen interest in these detective tales and even made suggestions which were not, I am bound to say, very practical. I kept in touch with him for many years.”

Later in his memoirs, Doyle writes: “I thought of my old teacher Joe Bell, of his eagle face, of his curious ways, of his eerie trick of spotting details. If he were a detective he would surely reduce this fascinating but unorganised business to something nearer to an exact science. I would try if I could get this effect. It was surely possible in real life, so why should I not make it plausible in fiction? It is all very well to say that a man is clever, but the reader wants to see examples of it — such examples as Bell gave us every day in the wards.”

I am well aware that Doyle had other inspirations for Holmes, such as the brilliant forensic scientist Dr Henry Littlejohn (1826-1914). Edinburgh’s first chief medical officer, he was, for more than 50 years, medical adviser to the Crown in many prosecutions, including the Ardlamont case in which he worked with Bell. Unlike Holmes but like Doyle, Littlejohn was knighted in 1895.

For his part, Bell was very complimentary about his pupil Doyle. He said in 1893: “I did not know he was coming out as a literary character but I always regarded him as one of the best students I ever had. He was exceedingly interested always upon anything connected with diagnosis and was never tired of trying to discover all those little details which one looks for.”

Bell and Doyle even joined forces in 1909 when, with other experts, they examined the case of Albert Patrick, a lawyer sentenced to death in the US for the alleged murder of his client William Marsh Rice. Patrick was eventually pardoned in 1912.

Of course, there is a theory that Doyle partly based Holmes on himself, but I think I have proved that Bell was the chief inspiration.

Now I will try to forensically examine this phenomenal medical man, a product of the Scottish system that I have shown in recent weeks made this small nation a world leader in medical science.

Bell was born on December 2, 1837, in Edinburgh. He was the son of Dr Benjamin Bell (1810-83) and his wife Cecilia Barbara Craigie. His great-grandfather, also Benjamin Bell, was widely considered to be the first Scottish scientific surgeon.

Given that lineage, it can be seen that Joseph Bell was destined for a career in medicine. After his education at Edinburgh Academy, he duly attended Edinburgh’s Medical School from which he graduated in 1859.

He studied surgery under the legendary Joseph Syme, who became his mentor. While still a student, Bell was selected to deliver a dissertation to the Royal Medical Society which has survived in their possession to this day.

Newly practising, Bell was for two years the assistant demonstrator of anatomy in the medical school and then became the house surgeon at the Royal Infirmary, later becoming a consultant surgeon. He would be associated with the hospital all his life.

The archive of the Royal College of Surgeons of Edinburgh records: “He went on to lecture on systematic surgery in Surgeons’ Square, attracting large classes who received his lectures with enthusiasm. But it was as a clinical teacher in the wards and clinics that Bell was in his element.

“His appointment as assistant to Syme in 1865 enhanced his prestige and security and allowed him to pursue two areas of interest which were to intrigue him for the rest of his life: handwriting analysis, and dialectology (the science of placing a person’s origin by accent and vocabulary). These were to prove valuable tools in his legendary diagnostic acumen and were to be exploited to the full by Conan Doyle in his fictional detective.”

Thanks to his new post, in 1865 Bell was able to marry Edith Katherine Erskine Murray and they would have two children, one of whom, Lieutenant Benjamin Bell of the Seaforth Highlanders, died at the age of just 23.

Combining surgery with teaching, Bell was soon renowned for the quality of his work and as a lecturer in the medical school, he began to demonstrate his ability in diagnosis with his methods of deduction.

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It was almost a party trick of his to deduce a man’s occupation and what he had recently been doing just by looking at him and noticing clues that other people such as his students simply did not.

One of those students was Doyle, who studied under him in 1877-78. Nine years later the first Sherlock Holmes story, A Study In Scarlet, was published to immediate acclaim. The rumour that Bell was the inspiration for Holmes swept through Edinburgh’s medical circles and could hardly be denied.

Bell was actually quite pleased, not least because he had never sought public acknowledgement of his “other” career in assisting the police with prosecutions in cases that needed a doctor’s expertise.

His contribution to forensic pathology was immense. He advised Scotland’s prosecution service, the Crown Office, on many criminal cases, usually behind the scenes but sometimes, as in the Ardlamont case, in full glare of publicity – something to which this modest man was averse.

He could not avoid his growing fame, however, especially when he was appointed surgeon to Queen Victoria, covering her many visits to Scotland. He also served as secretary, treasurer and, in 1877, president of the Royal College of Surgeons of Edinburgh.

With his royal connections, he was given the rare honour for a medical man of being appointed a Deputy Lord Lieutenant of his native city and was also a Justice of the Peace.

For more than 20 years he was editor of the Edinburgh Medical Journal and also published several books such as his Notes on Surgery for Nurses in 1891. It came from his work with nursing staff at the Royal Infirmary where one of his collaborators was Florence Nightingale to whom the work  is dedicated.

In all, Bell spent more than 40 years advocating for more and better-trained nurses and was vice-president of the Queen’s Nursing Institute Scotland. He was also instrumental in pushing Edinburgh University to allow women to study medicine.

In 1893, he broke his usual rule and decided to show his own evidence that he was the inspiration for Holmes. In a press interview, he described his deductive method: “I always impressed over and over again upon all my scholars – Conan Doyle among them – the vast importance of little distinctions, the endless significance of trifles.

“The great majority of people, of incidents, and of cases, resemble each other in the main and larger features. For instance, most men have apiece a head, two arms, nose, mouth, and a certain number of teeth. It is the little differences, in themselves trifles, such as the droop of an eyelid or whatnot, which differentiate men.”

Joseph Bell died on October 4, 1911, and was buried in Edinburgh’s Dean Cemetery with his wife and son. Scotland’s Joseph Bell Centre for Forensic Statistics and Legal Reasoning is named after him.