The man who inspired Sherlock Holmes also deduced the value of well-trained nurses

New research from QNIS shows Joseph Bell’s role as an advocate for the profession

New research from Queen’s Nursing Institute Scotland shows Joseph Bell’s role as an advocate for the profession

  • Dr Bell believed trained hospital nurses would cut patient mortality by at least 50%
  • He corresponded with Florence Nightingale, to whom he dedicated his book Notes on Surgery for Nurses
  • As vice-president of the early QNIS, he helped establish training for district nurses in Scotland 

Joseph Bell. Picture: Alamy

Surgeon Joseph Bell is known as the inspiration for the fictional character Sherlock Holmes. But his greatest achievement was the contribution he made to modern nursing.

New research for the Queen’s Nursing Institute Scotland (QNIS) shows his enthusiastic and practical support for nurses spanned more than 40 years.

The Royal Infirmary of Edinburgh
during Dr Bell’s era.
Picture: Alamy

Dr Bell came from a family of doctors and qualified in Edinburgh in 1859. At that time, he painted a grim picture of the nurses at Royal Infirmary of Edinburgh: ‘Poor old useless drudges, half charwomen, half field workers, rarely keeping their places for any length of time, absolutely ignorant, almost invariably drunken, and sometimes deaf.’

If nursing was in need of reform, then so too was surgery. A surgeon called Robert Liston is rumoured to have achieved a 300% mortality rate in one operation: the patient, one of his assistants whose fingers were accidentally amputated (both contracted gangrene), and a spectator who dropped dead from fright when Liston’s knife cut through his coat tails.

Florence Nightingale, who
corresponded with Bell.

Revolution and reform

Fortunately, the arrival of anaesthetics and antiseptics in surgery coincided with the revolution in nursing spearheaded by Florence Nightingale. She sent nurses trained at St Thomas’s in London to the Royal Infirmary of Edinburgh – and entered into correspondence with Dr Bell.

He believed trained hospital nurses would cut patient mortality by at least 50%. He was the first surgeon to offer lectures to nurses and invited them on his Sunday ward rounds.

There is no evidence that he and Nightingale met, but it is clear from their letters that they got on well.

Nightingale offered her gratitude for ‘all he [Bell] has done so wisely and so well for the causes of trained nursing’

Thanks to them, the Royal Infirmary was transformed by qualified nurses and well-run theatres. In 1880, Nightingale offered her gratitude for ‘all he [Bell] has done so wisely and so well for the causes of trained nursing’.

Early district nurses

The next challenge was nursing those who were poor and ill in their own homes. Queen Victoria’s jubilee in 1887 provided the opportunity to set up an institute for training district nurses. The impetus came from Liverpool merchant and philanthropist William Rathbone and from Miss Nightingale.

Princess Louise. Picture: Alamy

In Scotland the banner was taken up by three remarkable women committed to social reform: Christian Guthrie Wright (who had earlier set up the Edinburgh School of Cookery to teach the principles of nutrition); fellow campaigner Louisa Stevenson; and Princess Louise, Queen Victoria’s rebellious fourth daughter who, like Wright, was also a member of the institute’s executive council in London.

Dr Bell was involved from the outset as vice-president, setting up the institute’s Scottish branch, the QNIS. By that time he had left the infirmary to become the first surgeon at Edinburgh’s Royal Hospital for Sick Children.

Miss Nightingale wrote to Pauline Peter, the first QNIS superintendent, in February 1889: ‘I most earnestly hope that you are beginning under the conditions you and we wish for, and bid you success from the bottom of my heart. God bless you.’ 

The great detective

By 1892 word was spreading that the model for literary sensation Sherlock Holmes was an Edinburgh surgeon. Writer Arthur Conan Doyle had been one of Dr Bell’s brightest surgical assistants. He transferred Dr Bell’s talent for observation, lightning diagnosis and scientific deduction to his creation, Holmes, who became the world’s most celebrated detective.

Like Holmes, Bell had a wide range of interests… Unlike Holmes, he did not experiment with cocaine and was a dedicated family man

Sherlock Holmes in The Strand
magazine. Picture: Alamy

Doyle let the cat out of the bag to the Strand magazine, and then wrote to Dr Bell warning him: ‘I am afraid that my little sketches have had the effect of setting a newspaper man on your trail with as great persistence as even Holmes showed to his criminals.’

Dr Bell coped well with the press interest and remained on good terms with Doyle. Like Holmes, he had a wide range of interests and expertise, including chemistry, accents and handwriting. Unlike Holmes, he did not experiment with cocaine, was a regular churchgoer and a dedicated family man.

Passionate advocate of nursing

His passionate advocacy of nursing continued in his role as chair of the QNIS executive committee, which set out a different course for Queen’s Nurses in Scotland. They could only undertake midwifery, public health and district nursing courses after three years’ hospital training. This was not required for the large numbers of village nurse midwives in England.

Queen's Nurses flourished – by 1900 there were more 200 of them in post, and this rose to 1,000 by 1940, thanks to local nursing associations funded by charitable appeals.

Arthur Conan Doyle. Picture: Alamy

Dr Bell also worked as a personal physician to nurses at the QNIS’s training home in Castle Terrace, Edinburgh, and its convalescent home. A poignant letter from Princess Louise thanked him for his care of their good friend Miss Guthrie Wright in her final days.

Notes for nurses

On Dr Bell’s death in 1911, fellow doctor Charles Douglas recalled: ‘Joe Bell was so many-sided. The children, the women patients, the nurses all loved him for his kindness, his quick and ready sympathy, not one of them more so than she who knew him so well, his right hand through his long service, his beloved staff nurse, Jeanie Dickson, on whose judgement he relied far more than on that of most of his residents.’

His legacy includes Notes on Surgery for Nurses, the book he wrote and dedicated to Nightingale. It went through six editions and remains surprisingly readable, and genuinely sympathetic to the nurse just starting out. ‘Cultivate absolutely accuracy in observation and truthfulness in report,’ Dr Bell urged.

Chris Holme is a freelance historian and a former Reuters Foundation fellow in medical journalism

Further information

Read Dr Bell’s Notes on Surgery for Nurses 

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