Challenger Logo by Alan White   A Science Fiction Fanzine   Summer 2004

Dr. Craig Hilton chimes in from Melbourne with another medical look at Sherlock Holmes ...


The Resident Patient

- A Medical Opinion

Dr. Craig Hilton

Illustrations by Sidney Paget

The case of the murder of Mr Blessington is chronicled in the story The Resident Patient. Although Holmes' role as a detective this time is not greatly influential, the story provides the inquiring clinician some opportunity for analysis on the matters of human illness, medical practice and details of the crime.

Blessington was murdered by a collaboration of three men, who subdued him and subjected him to a lengthy verbal confrontation, proceeding then by force or intimidation to hang him. The deed was perpetrated in the early hours of Thursday 7th October 1886 (1), in the first-floor room Blessington had turned into his "safe-house" or fortress, in Brook Street, in the fashionable Cavendish Square district in London. It thus earned the popular name of the Brook Street Mystery, although any mystery as to the circumstances of the crime or its executors was dispelled very early on in its aftermath, partly thanks to some apt advice from Holmes at the scene. As tragedy would have it, the day prior to Blessington's murder, Holmes had conditionally offered him his assistance face-to-face, to have the offer spurned by the ever-fearful target.

Blessington, as it happened, was an invalid who was living in a constant state of apprehension of being run to earth by three former members of his criminal gang. The three had gone to prison - and a fourth hanged - on his Crown evidence, and their betrayal by him was what bought his own freedom from prosecution. He and his gang had robbed the Worthingdon Bank in 1875 and murdered the caretaker in the process. The haul was seven thousand pounds. British justice caught up with them swiftly, and before too long, the prisoners were languishing under fifteen-year sentences, later commuted to (probably) eleven. (2)

Blessington, or Sutton to give him his true name, was the worst of the gang - Holmes states this unequivocally. And yet how did this ringleader get off Scot-free when the others paid such a high penalty? The evidence against them was by no means conclusive, we are told. The chances of any convictions under law were uncertain, but with Sutton's evidence, serious prosecutions could be made. As the crime was known to have been committed by a gang of five, the Crown must have decided four scalps (three imprisonments and one capital punishment) were enough. Whether the Crown was fully aware of the leading part played by Sutton/Blessington in the crime is not clear. Certainly from the way Holmes remarked about the fact, he was aware of it. (3) Perhaps he had followed details reported in the paper. (Remember - back at the time the bank robbery was actually committed, detection was still only something of a hobby for him, and it would be another two or three years before he started consultative detection as a career.) He may have discussed the matter and shared and refined his conclusions with Scotland Yard over the following years, as by then he would have gained a higher reputation. By the time the story takes place, it seems Sutton is widely accepted as numbering among the criminals. Holmes matter-of-factly says he is well known at headquarters, and Inspector Lanner, at the drop of the names Biddle, Hayward and Moffat, can chip in with the name "Sutton" as the gang of five's missing member. (4)

The importance of this detail is two-fold. Firstly is the question of whether the stolen seven thousand pounds was ever recovered. The evidence suggests it was not, and Blessington ended up with it. When he offers an arrangement with Dr Percy Trevelyan to be his personal physician, he boasts of having a few thousand to invest. As an invalid, and therefore probably having been not gainfully employed for some years, he could only have been living off savings and/or investments. Therefore, he had substantial funds in 1886. Conversely, prior to 1875, he had little money - a legitimately rich man (or at least one with a substantial nest egg or a well-earning job) is hardly likely to take on the hazards of leading a bank robbery, especially if just for a split of the proceeds. These things are done out of need, and not for the increment on top of some honestly accumulated capital. There is the possibility that Sutton had a career as a big-time criminal, that the Worthingdon bank job was one of many, and that although he did not get any of this loot in the end, he had ample from others. The hypothesis is worth considering, but there is no hint from Holmes to support it. A more likely scenario is a financially desperate Sutton - no criminal mastermind on the one hand but no stranger to crime on the other - putting together a gang to pull off the biggest robbery of his ignoble career. The job was botched, a caretaker was killed and the police were onto them all. So Sutton sold the others out, took the money and ran.

The second question is whether he remained a marked man as far as Scotland Yard was concerned. Surely with the booty still missing, the authorities would have tried whatever was possible to keep tabs on him in the hope of something turning up that would lead them to it. One can imagine Sutton's assurances of his purely peripheral role in the affair as he doled out his damning testimony against the other four robbers, but the men at the Yard were not completely gullible. So what could he have done next? Kept his head down, attempted no more crimes on this scale, indeed phased himself out of crime completely, lived modestly on the money and tried not to spend it all at once. Changed his name to Blessington and gone into hiding from both the law and his mates.

Did he succeed, and give the Yard the slip? Especially in the later years, when he was identified as one of the five, could he live in London and get away with it? It seems so.

Did he give his mates the slip as well? They would have had the strongest of grudges, not to mention the sure knowledge of his involvement in the gang from the beginning. It is always possible for the well-connected inmate to "get to" someone on the outside, via a proxy. However, while they were still under lock and key, Sutton/Blessington was simply cautious, and not fearful, indicating that he knew they were not well-connected at all, and that they could only come after him themselves after release. Even so, he correctly guessed how quickly they would be able to locate him when they did.

Whether he stayed the whole eleven years in London, hid out somewhere else in the British Isles or spent time abroad could form the subject of another article. The fact is that in the final years, he chose London for his home, for one reason or another, and was duly condemned to a life of concealment and confinement. Possible reasons may include sentimental love for the city, a compelling social liaison, a compelling business liaison and the impression that the metropolis could offer him an unequalled level of service in many fields, including medical.

The plan, it seems, was to live on the dividends of his capital, remain safely secluded and have his ongoing health needs attended to. This is when he put his proposal to the receptive young Doctor Trevelyan. Blessington would provide the consulting rooms and lodgings, and Doctor Trevelyan in return would work hard to earn as much money as possible, dividing the proceeds between the two (disproportionately in Blessington's favour.) Additionally, Blessington had the permanent on-call services of the doctor for his infirmity. 'His heart was weak, it appears, and he needed constant medical supervision.' The clinical reader asks: what was the nature of the heart condition?

Dr Trevelyan does not so much as hint at it, nor does his fellow Doctor Watson probe him for details. Professional confidentiality may have been the reason, or the thought that it may not have been relevant. Neither is very convincing. It is necessary to look elsewhere for clues.

When Holmes and Watson first lay eyes on Blessington, he is described as follows: '…we saw before us a singular-looking man, whose appearance, as well as his voice, testified to his jangled nerves. He was very fat, but had apparently at some time been much fatter, so that the skin hung about his face in loose pouches, like the cheeks of a bloodhound. He was of a sickly colour, and his thin, sandy hair seemed to bristle up with the intensity of his emotion.' Later, when the body of the unfortunate man is found hanging, it is described thus: 'It was a dreadful sight which met us as we entered the bedroom door. I have spoken of the impression of flabbiness which this man Blessington conveyed. As he dangled from the hook it was exaggerated and intensified until he was scarce human in his appearance. The neck was drawn out like a plucked chicken's, making the rest of him seem the more obese and unnatural by the contrast. He was clad only in his long night-dress, and his swollen ankles and ungainly feet protruded starkly from beneath it.' (5)

So Blessington, who was very fat, had lost a lot of weight even at a minimum level of exertion. This would imply he was taking little food, or his illness was consuming him, or both. There are only a few heart-related illnesses that burn up body fat. Some conditions such as cancer would have damaged him faster. He could have gone off his food through fear, depression, illness, side effects of his medications or even a conscious effort to reduce weight. There is also the possibility that he had lost muscle instead of fat. An invalid's chronic inactivity leads to wasting of the muscles, which in itself can make him look flabby.

His skin was sickly in colour, implying he looked pale. Anaemia - weak-quality blood - can give this appearance, but then so can fear. Or standing under a gaslight. Anaemia at any rate can cause heart failure due to the fact the heart has to pump more poor-quality blood around the system than it would blood of normal strength.

His ankles were swollen. Even adjusting for the fact that ankles do swell when someone has been hanging for a few hours, this still suggests heart failure. Fluid in the feet and ankles is almost an essential part of a failing heart, once it has been going for any length of time. As the heart is failing in its strength to pump sufficiently for the body's needs, anything more than mild activity is exhausting. Moreover, fluid accumulates in the lungs (hence the name congestive cardiac failure), reducing their ability to oxygenate the blood. Anything more than mild activity causes severe shortness of breath.

A doctor's mention of swollen ankles is tantamount to a diagnosis of congestive cardiac failure - a weak heart. This is a starting point, but before we continue, one could ask: "how weak?" Well, by Trevelyan's description, Blessington chose his rooms on the first floor, a level higher than the ground floor consulting rooms, that is, typically two flights of steps. Every evening, Blessington came down to the consulting rooms to examine the books and take his share of the earnings back up to the strong-box in his room. Two flights of stairs would be quite a challenge to someone of Blessington's size if he had moderate failure, and totally impossible if it was severe. Additionally, Blessington's daily habit was to take a short walk before dinner, at about six o'clock. (He was out of the house at the time of the quarter past six appointment.) It seems that from the ground floor consulting office there was a descent to street level, as Dr Trevelyan's page boy 'waits downstairs, and runs up to show patients out.' Walking at a gentle pace on level ground is not taxing at all, but once again climbing all the way back to his room would be a substantial challenge to a weak heart. Surely if Blessington routinely collapsed into his chair, gasping for breath for half an hour, twice a day, his doctor would considered this significant enough to make note of it. The fact that he does not leads the clinical reader to guess that we are dealing with a longstanding case of no more than mild congestive cardiac failure.

So, what can cause congestive cardiac failure? Quite a lot of things, among them a heart attack (from atherosclerosis or fatty blockages of the arteries, considered a modern-day illness but more generally associated with over-indulgence in fats), high blood pressure (existing alone or itself the result of another condition, perhaps the diseased kidneys that would take away the appetite), malfunctioning valves (including the result of rheumatic fever, a disease of the poor), anaemia (from many causes, although if due to poor nutrition such as lack of iron it would have been remediable by the doctor) and disordered heart rhythm (such as atrial fibrillation, which in turn can be secondary to such maladies as an overactive thyroid gland - one of the abovementioned diseases that burns up body fat.)

For someone with no more than mild heart failure, Blessington seems to have been very worried about it - worried enough to set up this arrangement and imprison himself in the midst of London for 'constant medical supervision'. What he appeared to be receiving was simply a daily physical check-up on a regular, scheduled basis. They were obviously not very demanding, as evidenced by the description: "I have got in the way of late of holding as little communication with him as possible." One could picture the scene of the sessions: brief, silent and businesslike.

Blessington may have wanted medical availability not because of his usual health status but for times of unexpected need. Sometimes a heart condition can be unstable: all can be going well, until a sudden attack of angina pain or a dangerous (or simply frightening) heart irregularity demands immediate remedy. But no mention is made of any call system - such as a bell - to alert Dr Trevelyan of the need for urgent assistance, either when he is busily consulting during the day or sleeping during the night. An alarm system surely did not exist, otherwise its highly significant presence would have been commented upon by Holmes. And as for an angina treatment - amyl nitrate - Dr Trevelyan kept it downstairs in his laboratory, where (as we know) it took him five minutes to locate. No, Blessington seems to have had mild cardiac failure, purely and simply, with no unexpected crises. Why then did he so want the permanent availability of a doctor?

Here is another suggestion. He wanted it for reassurance. To an extent, Blessington's incapacity may have been his conviction that he was incapacitated - he feared for his heart and strived to protect it accordingly, with strict rest and avoidance of stressful situations. Strange as the remedy may seem, this was consistent with standards of the time. Ironically, the more a man in this condition is told he has to rest his heart, the more he fears for its well-being, and becoming attuned to every symptom, daily he senses his fears being borne out. As Blessington went to the trouble of setting up a secret hideaway, structured around the permanent availability of a private doctor, his fear for his heart must have been substantial, to have given it such priority.

What, then, was the medical diagnosis of the resident patient? Many possibilities cannot be eliminated, but doctors and detectives work by the motto: Common things occur commonly. I think Blessington had hypertension, that is, high blood pressure. I think he had a nervous and insecure personality, hidden by a veneer of bluster and bullying. The blood pressure gradually weakened his heart and led to congestive cardiac failure. Perhaps along the way, the heart was dealt another blow with a myocardial infarction, that is, a heart attack, further weakening it and further shattering his confidence in his tenancy on this mortal coil. While digitalis may have ameliorated the severity of the failure, it robbed him of his appetite and made him feel listless and sour. Despite medical care, his health continued to deteriorate slowly, although when news came to him of the release of his betrayed comrades, the unrelenting anxiety that now racked his system was enough to raise his blood pressure still further, and worsen his heart failure. I cannot prove this conclusively, but it is a reasonable best guess.

At the end of the nineteenth century, cardiovascular conditions were poorly understood. The sphygmomanometer (blood pressure machine) and electrocardiograph (heart trace) were still yet to be invented. Julius Cohnheim associated heart aneurysms with blockage of blood supply via the coronary arteries. Carl Weigert gave one of the early, classic descriptions of a heart attack in 1880. Even by 1892, Sir William Osler still described coronary disease (that is, heart attacks and angina) as 'relatively rare'. In terms of treatment, the little that was available since the mid-eighteenth century for heart failure was digitalis, identified by William Withering.

In 'The Doctor, The Detective and Arthur Conan Doyle', Martin Booth says; "doctors educated in the 1880s were the first 'modern' doctors. They were the first to be trained in the use of simple diagnostic methods, were the first in their profession to wear stethoscopes round their necks, shake the mercury down in their thermometers and time their patients' pulse against a pocket watch with a sweep second hand. Basic laboratory techniques were taught, microscopes were in common usage in pathology classes, and medicine was moving ahead in leaps and bounds with the more obscure fundamental functions of the body being studied and understood for the first time. As never before, diagnoses were being made upon considered detail and interpretation of symptoms, not just on educated guesswork or quackery: observation was, however, still the key word."

Booth is not gentle on the realities of medicine as a profession, for the young doctor trying to start out in a career. "After [a demanding] course of study, he then had to buy himself into a practice, or set up one himself from scratch, had to follow a set code of dress and behaviour and, in general, appear to be of a solid and trustworthy nature. Few doctors … ever became rich."

Just such was Dr Percy Trevelyan's situation, when he looked to move from distinguished post-graduate research into private practice. He had what he judged to be an excellent earning potential, but very little starting capital. He settled for general practice, but had an eye to moving to specialise in neurology. In order to gain the following of the most lucrative clientele, it would somehow be necessary to demonstrate the semblance of success and prosperity, until he could reinforce this with a sound professional reputation.

This was the situation, when Blessington approached him with his "strange proposal." As it goes, in this day and age, the proposal is not strange at all. How times change. Under the arrangement, Blessington would set the doctor up with rooms in the best area, that would include presumably the staff - maid(s), cook and page boy - equipment, consumables and of course accommodation. For this, he would give the doctor one quarter of everything he earned. In modern terms, this is similar to a corporate medical organisation providing a doctor the wherewithal to practice and taking a 75% service fee. Considering the quality of the location and the provision of staff, and with accommodation thrown in, the figure of 75% seems quite supportable. In any case, it was in Blessington's best interest to make the offer attractive - he would be the loser if it fell apart.

The Blessington who first makes the offer comes across as a brash, confident and personable businessman, and not the fearful invalid he seems later to have degenerated into. Yet there is one small hint of pressure. The act of approaching Dr Trevelyan is an obvious case of seizing the moment, upon spotting just the right little earner. Why else would a man fearful of his heart choose someone famous for his excellence in neurology? And while claiming to be "perfectly frank" in the presentation of the business offer, Blessington omits to mention his need for constant medical supervision. "His heart was weak, it appears," says Trevelyan, almost as if it was thrown into the deal as an afterthought. Well, thank you for telling me.

"I won't weary you with the account of how we bargained and negotiated." On the contrary. Questions such as who would take over and who would own the rooms when Blessington died would have been of the highest interest to Holmes. At the end of the story, so much remains unaccounted for.

When did the first meeting take place? It is not stipulated, and again surprisingly, Holmes does not pick the point up for clarification. In Trevelyan's words: "I may say with confidence that he never had occasion to regret his speculation. From the first it was a success. A few good cases and the reputation I had won in the hospital brought me rapidly to the front, and during the last year or two, I have made him a rich man." Allowing a short time before he built up a profitable client load, the set-up was probably two or three years prior to the case, therefore 1883 or 1884.

At twenty-five per cent of the wealth, Dr Trevelyan would have been doing very tidily. By all appearances, he was not spending it on women or high living. It would have been sensible to save up for the day his resident patient died and he had to start up a place of his own. This was likely the case.

Similarly, Blessington was evidently raking it in on his investment, although unlike his doctor, he had little prospect of using for a happier life. "He was a man of singular habits, shunning company and very seldom going out. His life was irregular, but in one respect he was regularity itself. Every evening at the same hour, he walked into the consulting room, examined the books, put down five and threepence for every guinea that I had earned, and carried the rest off to the strong-box in his own room." Blessington would not bank it, but kept it all in the box in his room, as he later told Holmes (6).

Whether he had a visiting intermediary, accountant, solicitor or other professional in his time shut away in a couple of rooms in Brook Street, to help him carry out the routine necessities of a business, is a mystery, as are the security arrangements for his protection. The count of people with access to the house includes Dr Trevelyan, one or two maids, a cook and a page boy at least.

Furthermore, Blessington would lock himself in his room. But for the sake his medical supervision, surely his doctor would have had the ability to get in. It is also mentioned that the maid could get in, to bring him his morning cup of tea, as it was she who found the body hanging. Exactly how many keys to the locked room were floating around the place? A few weeks prior to the case, when Blessington unaccountably went into a state of considerable agitation, having heard that his comrades had been released early from prison and being in mortal dread of their vengeance, he ordered stronger bolts on the windows and doors. But he still does not seem to have solved the problem of the weak human link in his administration.

Blessington's pre-dinner walk may have been the innocent daily constitutional it is put up to be. However, it is fun to speculate on some surreptitious, deeper purpose. Was there a shady contact he used for keeping in touch with events in the underworld? Indeed, was he paying someone off, to keep under wraps the expensive secret of his hidden identity? (7) When he heard the news at first, Blessington ceased taking his walk for a week, either because he would not or because he could not. If it was from the fear of being seen and pounced upon, then he regained his confidence in due course. If it was because his blood pressure had risen to the point of worsening his congestive cardiac failure, then he was doomed to stay indoors, even when there was 'hush money' to be delivered. Indeed he may have believed his final hour had come whatever the case. But the crisis passed. Unfortunately, the gang managed to track down Blessington (alias Sutton) in short order, even though Scotland Yard had failed for all those years. Perhaps there is something in the hush money theory after all.

A word about catalepsy. It is a disease in the family of epilepsy. When there is a wave of uncontrolled electrical activity over the surface of the brain, it can cause generalised convulsions, seizures either in one part of the body such as the arm, hallucinations, lapses of attention, sleep or complete paralysis, depending on the pattern and location. Some people are prone to these unwanted 'short circuits', and may have the same pattern on a recurrent basis. When the sole effect is paralysis, it is called catalepsy, and it is rare.

Dr Trevelyan was particularly interested in neurology (8), and although he started out in general practice, his goal was to specialise. The late nineteenth century saw immense strides in the untangling of the complex knot of phenomena that is the nervous system. People such as Moritz Romberg, Guillaume Duchenne and Jean-Martin Charcot studied disorders in movement, feeling and behaviour, caused by everything from injury to syphilis, and tried to make sense of how they originated from malfunctions in a well-ordered brain, spinal cord and peripheral nerves. Until the end of the century, no clear distinction had been made between what we would understand as the problems of the body and the problems of the mind - neurology and psychiatry.

This is understandable, given the complexity of what they had to work with: general paralysis, neuralgias, seizures, epileptiform fits, spastic symptoms, tabes dorsalis and hysteria. Indeed, the catch-all title, 'neurosis', is now reserved as a specific psychiatric term. Sigmund Freud graduated in 1881 and specialised in clinical neurology, until the 1890s, from which time he ventured into his ground-breaking work that virtually invented the discipline of psychiatry. Other workers such as Paul Broca, Hughlings Jackson, H. C. Bastian and Carl Wernicke contributed to the understanding of the higher functions of the cerebrum, which demonstrated for example how a person with damage to a particular spot on the surface of one side of the brain would be able to do everything except talk.

These were the heady (if you'll pardon the pun) times of neurology, and by now you'll have some feeling for Percy Trevelyan's fascination with the science. For example, when someone is sitting unresponsively in a chair, there is all the difference in the world between being frozen with fear in a severe case of emotional shock (hysteria) and an epileptic attack (catalepsy).

Once Blessington's former gang members had done their time inside, they were intent on finding him and wreaking their revenge. The finding was achieved in short order, but as to the next step a more inept band of executioners would be hard to imagine. For all the long years they spent brooding in prison, they seem to have been remarkably light on for planning, when it came to action. Two of them arrange to enter the house, posing as a patient and his son, in an appointment specially booked for the end of the consulting day. While one occupies the doctor's attention, the other gives his excuses to leave the room, and then is free to roam the house looking for the target. He may or may not enter Blessington's room the first time, but he does the second time, the following day. Later that night, or rather in the early hours of the morning, both men and a third find their way into the house by stealth, enter Blessington's room, subject him to the pretence of a trial and hang him, having brought the necessary equipment with them in case they cannot not find what they need in the room.

They have located Blessington's residence. They know he spends nearly all his time barricaded inside. Obviously they have not spent any time staking the place out, nor asked around, or they would have known he goes out for a daily walk at that time. On the first intrusion, by a thin, elderly man and a large Hercules of a specimen, the Hercules does the secret prowling. He would fully expect to find Blessington in his room, so no doubt he plans to handle the confrontation as it happens, to assault and kill him single-handedly. The door to the room would certainly be kept locked while Blessington went out for his walk, so when the Hercules enters the room the second day, he must have picked the lock. (If he entered the first day, he must pick the lock then, too.) Stupidly, he leaves muddy footprints on the carpet. So much for the element of surprise. He also fails to find the hook in the ceiling, the rope under the bed and the money in the strong box. (9)

Furthermore, what could be more ridiculous and unnecessary than a puny, low-life ex-con posing as a Russian nobleman? Or a large jail-hardened thug play-acting the part of a loving son of such a sensitive disposition that he may die if he were to see his father have an attack of catalepsy in the consulting room? Or the likelihood that the doctor will let the thug wander unsupervised around Blessington's fortress? Or the likelihood that Blessington does not have a gun at the ready, or a way of calling for help? What possesses the old man to try to fool an expert in neurological diseases by feigning an attack of an exceptionally rare neurological condition? Indeed why does he imagine the best way to cover the sound of mayhem, bludgeoning and possible gunshots upstairs is to sit in complete silence for an indeterminate period of time? Why does he take the chance to scarper as soon as he is left alone in the room? It is all very strange. The next day, the two return, laughing off the previous day's absconding as a minor misunderstanding, (10) before going through a repeat performance, this time without catalepsy. The complete lack of forward planning has all the hallmarks of ineptitude.

On the third venture, in the middle of the night, the gang members have a confederate in the house to let them in. The page boy, recently commenced in service, is blamed. Given such a lack of inside knowledge of Blessington's arrangements in the first two attempts, it seems likely to me that the insider was recruited only on the final night, so truthfully it could be any of the staff and not just the member with the shortest length of service.

Once again, the questions: why the sudden change of plan, with the third man, the inquisition and what could have been a very clumsy hanging? Had the man just caught up with his two mates that evening and taken charge of the operation? When they were picking the lock (11) to Blessington's room, did they really expect that he would remain asleep or paralysed by fear, instead of taking aim with his gun, or rousing the other occupants of the house, or climbing out of the window? If they took the trouble to make it look like a suicide (arranging for the door to be bolted behind them), why were they careless enough to leave their cigarette butts and tools behind? What would they have done if Blessington had objected to being strung up? In the eleven years they were banged up in prison, did they do any preparatory work at all?

I think that, based on their track record, the Worthingdon Bank Gang were a group of bungling, second-rate crooks who got lucky. The fact is that chance played a big part in the success of a very flawed assassination, yet chance also put Sherlock Holmes onto it, without whose help the case would undeniably been mis-recorded as a suicide.

The clumsy bungling in the 1875 bank raid led to an innocent man's death and the end of a criminal career. Even accounting for his crimes, the reader can be forgiven for having some empathy with Blessington/Sutton for having sold his unreliable and dangerous colleagues into prison in the first place. Thereafter, even if only for a few years, he paid dearly by becoming a prisoner thrice over - a prisoner of his walls, and a prisoner of his mind, and a prisoner of his body. Holmes' final comments are: "However, wretch as he was, he was still living under the shield of British law, and I have no doubt, Inspector, that you will see that, though that shield may fail to guard, the sword of justice is still there to avenge."

Sadly, human infirmity can imprison a man without regard to justice. It can be relied upon not as a fair law to those who deserve correction, but a lock in need of a key. On this principle Dr Watson, Dr Trevelyan, their antecedents and your humble clinical reader would be in total accord.



1. According to Baring-Gould [Return to text]

2. Again, Baring-Gould's estimate.  [Return to text]

3. Alternatively, Holmes was mistaken.  [Return to text]

4. The fourth was Cartwright, later to be hanged.  [Return to text]

5. With such a vivid description, it would suggest Sir A.C.D. had witnessed a similar scene.  [Return to text]

6. Unless this was one of his many lies.  [Return to text]

7. In which case, he may have been poor, as he claimed.  [Return to text]

8. To be more precise, neurology is the study of the normal nervous system. The study of diseases of the nervous system is neuropathology, and a doctor who treats people in this field is a clinical neurologist.  [Return to text]

9. On the third and final intrusion, the gang of three have brought screws and a hook they did not need, a block and tackle they did not need, and completely fail to do anything with the stash of money that this was about in the first place. Honour amongst thieves would hardly extend to refusing to make off with a dead man's loot!  [Return to text]

10. These days, when an unsupervised patient wanders out in a confused state and disappears, a doctor's first port of call would be the emergency services, and the second his medical defence organisation!  [Return to text]

11. What they did was to force the lock. Holmes says: "With the help of a wire, however, they forced round the key." This cannot be true, since if Blessington left the key in the lock, neither the maid nor Dr Trevelyan would be able to get into the room themselves, even with a key of their own. We know on this occasion the maid certainly did, as she found the body in the morning. Either Holmes was mistaken in his comment or Watson in the documentation.  [Return to text]


Baring-Gould, William S. (Ed.) The Annotated Sherlock Holmes London: John Murray, 1960

Booth, Martin. The Doctor, The Detective and Arthur Conan Doyle: A Biography of Arthur Conan Doyle London: Hodder and Stoughton, 1997

Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present London: HarperCollins, 1997


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