Joseph Bell

Joseph Bell was the last in a famous Edinburgh surgical dynasty. His great grandfather, grandfather, and father before him had all been Fellows of the College and surgeons in Edinburgh. Like his father he became President of the College; but it was his powers of observation, diagnostic acumen and the way he demonstrated these to medical students that were to bring him particular fame. One of those students, Arthur Conan Doyle, used him as the model for Sherlock Holmes.

Joseph Bell was educated at the Edinburgh Academy, and entered Edinburgh University when he was 16, passing his final examinations before he was 21. Since childhood he would have heard from his father in glowing terms about the University of Leyden in Holland, from which the Edinburgh Medical School derived, and which still attracted ambitious young doctors from all over Europe. Already described as “keenly observant, methodical and thorough” he decided to pursue his training in Edinburgh and became House Surgeon to James Syme and House Physician under John Gairdner. He had impressed Syme with his graduation thesis “On epithelial cancer” and Syme was to become his hero and mentor. There followed two years as demonstrator in anatomy under Professor Goodsir and it was here that he developed a reputation for powers of observation of meticulous detail and outstanding ability as a teacher. 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.

Arthur Conan Doyle was born in Edinburgh in 1859 at Picardy Place and enrolled in the Medical School in 1876. His contemporaries at the University included J. M. Barrie and Robert Louis Stevenson with whom he was to collaborate in the later years and his teachers in the Medical School included Joseph Lister and James Young Simpson. Yet it was Joseph Bell who made the greatest impression on the young Conan Doyle. Bell selected him as his clerk, a patronage similar to that which Bell had received from Syme 20 years earlier. From here emerged the concept of Sherlock Holmes. Conan Doyle was later to write “I thought of my old teacher Joe Bell, of his eagle face, of his curious ways, and his eerie trick of spotting details. If he were a detective he would surely reduce this fascinating but disorganised business to something nearer an exact science.” Doyle sent the manuscript for A Study in Scarlet to Robert Louis Stevenson, by then an exile in Samoa. Stevenson, who had spent his early life in Edinbugh, wrote back to Doyle in April 1893 “I ……… offer my compliments on your very ingenious and very interesting adventures of Sherlock Holmes. Only one thing troubles me: can this be my old friend Joe Bell?” In a now famous letter in the College archive, Conan Doyle wrote to Joseph Bell on 4th May, 1892 “it is most certainly to you that I owe Sherlock Holmes and although 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 of the effects which I have seen you produce in the out-patient ward.”

Dr. Watson too was almost certainly based on Patrick Heron Watson – in Conan Doyle’s time as a student simply Dr. Watson- but later Sir Patrick Heron Watson, President of the College (QV). Heron Watson had many of the attributes conferred on Holmes’s Watson. He was a bronzed military man with a moustache, who had trained in the Crimea, was an expert in forensic medicine and on gunshot wounds. Amongst other contenders as the model for Watson, was Sir Henry Littlejohn (qv)

It seems strange looking back that Bell’s time-limited appointment to The Royal Infirmary ended when he was only 49-years-old. He moved to what was effectively a second career at The Royal Hospital for Sick Children located initially at Meadowside, and from 1892 in Sciennes Road. His protégé Francis Caird, later to become Professor of Surgery, was to write of Bell’s most outstanding qualities. He wrote of his punctuality; of “the atmosphere of bonhomie and kindliness with which he surrounded his following of staff, students and patients”; “an excellent operator, dextrous, rapid and neat”; but most of all “his diagnostic acumen, his keen powers of observation, his skill in eliciting facts; and of “his sense of humour.” His association with The Royal College of Surgeons of Edinburgh was influential. He was Secretary and Treasurer for 11 years from 1876 and President from 1887 to 89.

Bell left legacies in two other areas. His appointment as Surgeon in Charge in the Royal Infirmary in 1871 coincided with the introduction of the new system of nursing imported from St. Thomas’s Hospital in London. Throughout his life he maintained an interest in the continuing development of nursing care. He helped to establish The Royal Edinburgh Hospital for Incurables, later the Longmore Hospital, recognising the importance of the surgeon’s duty of care to what was then an all too neglected group of patients.

Ironically, for one who inspired so much writing he was not a prolific writer himself, but for 23 years was editor of the Edinburgh Medical Journal and his “Manual of the Operations of Surgery” enjoyed the success of seven editions during his lifetime.

In his later years he exchanged the horse and trap in which he did his rounds for one of the first motor cars in Edinburgh enjoying long drives in the country from his beloved summer home in Mauricewood near Penicuik. It was there that he died in 1911.

Bell’s legacy to Edinburgh surgery, to its College and to its hospitals is enormous. The emphasis on detailed observation, logical deduction and diagnosis; on the importance devoting time to teaching formed the basis of the model by which the Edinburgh School of Surgery came to be judged. His early championing of Lister’s carbolic spray helped to promote its widespread introduction.