Paging Dr. Sherlock Holmes: Please report to neurology


What could a neurologist possibly have in common with such legendary fictional sleuths as the hard-drinking Philip Marlowe, the impossibly perceptive Sherlock Holmes or even rumpled Detective Colombo?

Pretty much everything, say two experts.

In an offbeat paper published Wednesday in the journal Practical Neurology, authors argue that detective stories have been part of the fabric of neurology ever since it became a discrete medical specialty.

When searching for clues to make a diagnosis about a nervous system disorder, neurologists employ a distinctly Holmesian alter ego, according the study’s coauthors, Dr. Peter Kempster, a neurologist at Australia’s Monash Medical Center, and Andrew Lees, professor of neurology at University College London.


In fact, published case histories often read like solved mysteries.

“Like conventional detective stories, they are reassuring, affirming the belief that even obscure neurological maladies can be diagnosed,” authors wrote.

Oliver Sacks, author of “The Man Who Mistook His Wife for a Hat,” is the bestselling, if not best known, neurologist author.

Although Sacks doesn’t write detective fiction, he does “give himself the role of detective -- observing gently questioning and sometimes searching out clues in the streets or homes of patients,” according to the authors.

There are several neurologists, however, who have specialized in writing detective fiction: Peter Gautier-Smith, Harold Klawans and Robert Joynt.

Gautier-Smith, who wrote 31 crime novels under the pen-name Peter Conway, said he began writing detective fiction on a dare. “Having struggled to produce a monograph on parasagittal meningioma, he wagered a friend that he could more easily write a novel,” the authors wrote.

While Klawans, an expert on Parkinson’s disease, set his first novel in a contemporary hospital, Joynt wrote several short stories that enlisted Holmes as the protagonist.


“Joynt tried to satisfy the deep-seated desire of many neurologists for a professional kinship with Sherlock Holmes,” study authors said.

The authors note that physician authors tend to prefer poisons to blunt-force trauma in their mysteries, and neurological maladies are always lurking. (Joynt’s first story features a thief who suffers from tabes dorsalis, a degenerative nerve disorder that affects balance.)

Of course, the original physician writer was Arthur Conan Doyle, who created Holmes, and made literary use of such disorders as epilepsy and stroke, as well as neurotoxins.

Though not a neurology specialist, Doyle had conducted postgraduate research on tabes dorsalis, and was therefore familiar with neurological conditions, and with neurologists.

“While Dr. Watson is drawn as the archetypal good general practitioner, neurologists have always related to Holmes for his diagnostic prowess,” the authors wrote.

“Some biosketches of neurologists who were practicing at the turn of the 20th century seem to catch a glimpse of the personality of Holmes: aloofness, an air of intellectual superiority bordering on arrogance and a hint of misogyny.”


The personality of neurologists has changed a good deal since Doyle’s time, but their desire to solve mysteries has not, according to the study authors.

“By and large, neurologists are scrupulous, mildly obsessive introverts -- thinkers rather than doers,” the authors wrote.

“Like Marlowe, we encounter cases that run ahead of our understanding for far too long, leaving us to contemplate our limitations and the nature of the mysterious in clinical narratives.”