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It takes a medical Sherlock Holmes to solve complex neurological mysteries

The clinical case histories published in medical journals since the 19th century often read like mystery stories, say two neurologists.

“The skills of observation, inquiry and abductive reasoning that compose a good clinical technique have much in common with the methods used in the detection of crime.”

Is Sherlock Holmes the neurologist’s alter ego?

Yes, according to the co-authors of a delightfully quirky paper published Wednesday in the journal Practical Neurology.

“Successful outcomes in neurological practice often turn on an ability to identify clues,” write Dr. Peter Kempster, a neurologist at Monash University in Victoria, Australia, and Andrew Lees, a professor of neurology at University College London. “The skills of observation, inquiry and abductive reasoning that compose a good clinical technique have much in common with the methods used in the detection of crime.”

The clinical case histories that neurologists have been publishing in medical journals since the 19th century often read like mystery stories, say the two neurologists.

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“Like conventional detective stories, [the case histories] are reassuring, affirming the belief that even obscure neurological maladies can be diagnosed,” they write.

Indeed, as the two neurologists point out, the British-American neurologist Oliver Sacks has masterfully turned such case histories into best-selling books.

“In many of [his neurological case histories],” say Kempster and Lees, “Sacks gives himself the role of detective — observing, gently questioning and sometimes searching out clues in the streets or in the homes of his patients.”

Sacks even gives his case histories Sherlock Holmesian titles, such as “The Man Who Mistook His Wife for a Hat,” “The Disembodied Lady” and “The Man Who Forgot How to Read.”

Neurology’s Agatha Christies

Several neurologists have actually turned to writing detective stories, Kempster and Lees point out. One of these was Dr. Harold Klawans (1937-1998), a noted authority on Parkinson’s disease, who wrote five crime novels, including “Sins of Commission,” which has a neurologist as its detective.

“Klawans developed this idea from a case that he and younger colleagues (who appeared, variously disguised, in the story) had seen in consultation,” write Kempster and Lees. “…The main character is clearly the author at the pinnacle of his clinical power, and he is given Sherlock Holmes’ capacity to observe details, infer other people’s thoughts and perform astonishing feats of abductive thinking from seemingly minor clues.”

Another neurologist, Peter Gautier-Smith, has written 31 crime books under the pen name Peter Conway. According to Kempster and Lees, Gautier-Smith started his fiction-writing career after making a bet with a friend that writing a novel would be a lot easier than writing a medical monograph on parasagittal meningioma, which he was struggling to finish at the time.

Neurology features prominently in Gautier-Smith’s novels.  “Various neurological disorders appear, and there is the established preference of the medical detective author for poison over firearms,” note Kempster and Lees.

Sherlock Holmes and neurology

But the most famous physician detective writer is, of course, Arthur Conan Doyle, the creator of Sherlock Holmes. Although Conan Doyle was not a neurologist, he did receive some medical training in the field, and neurological diseases — “including epilepsy, catalepsy, stroke, chorea and various forms of neurotoxicity” — make frequent appearances in his stories, Kempster and Lees point out.

“Neurologists have always related to Holmes for his diagnostic prowess,” they claim. Biographical sketches of practicing neurologists at the turn of the 20th century, when Conan Doyle was writing, showed “glimpses of the personality of Holmes: aloofness, an air of intellectual superiority bordering on arrogance and a hint of misogyny,” they write.

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Kempster and Lees also propose that some of the characteristics that Conon Doyle gave his iconic sleuth — “a reliance on a rigorous technique, a compulsion to instruct, an artistic intuitive flair in problem-solving and the knack for presenting pithy statements of principle” — might have been drawn, at least in part, from the larger-than-life personality and observational skills of French neurologist Jean-Martin Charcot, who was at the height of his fame when the initial Sherlock Holmes stories were written.

Neurologists should study Holmes

The Holmes stories, like other great works of detection fiction, “reflect back to us some images of our best selves exercising our craft,” Kempster and Lees tell their fellow neurologists. Yet, they lament, “more and more these days, some neurologists resemble Holmes’ police associate Inspector Lestrade with a slavish adherence to protocols and algorithms.”

So Kempster and Lees have a homework assignment for all medical students contemplating a career in neurology. “Novice neurologists in search of inspiration for a future career should purchase The Adventures of Sherlock Holmes,” they suggest. “This collection of the first, highly popular series contains some of Conan Doyle’s best short stories. Sherlock Holmes appears at his most incisive and bohemian, and is relentless in his pursuit of the correct diagnosis.”

“Excellent!” [cried Dr. Watson].

“Elementary,” [replied Holmes].

You’ll have to do some sleuthing to find a full version of this paper, because it’s behind a paywall on Practical Neurology’s website.