Elementary

In 1948, a 24 year-old man named Glen Bell opened a hot dog stand in the sleepy town of San Bernardino, California. Business at Bell’s Drive-In was pretty good, so good that in 1952 he sold the stand and built a new, more perfect one based on his experience running the first.

As fate would have it, in 1940 two brothers named Dick and Mac McDonald took over their father’s barbecue joint in Monrovia, California. It had been known as “The Airdrome” because it was located by the airport, but the brothers moved the entire building to San Bernardino, where they renamed it “McDonald’s Famous Barbeque”. In 1948, the brothers sat down and figured out that their most popular items were burgers, fries and shakes. So they shut the place down for a while and streamlined the entire operation around only those items. They reopened the restaurant as “McDonald’s” on December 12, 1948.

The brothers’ new restaurant was incredibly popular, so Bell tinkered with his menu to differentiate his place from McDonald’s. Bell loved Mexican food, and tacos seemed like a natural fit. He tweaked his chili recipe into a taco meat recipe, and tacos were soon the best-selling item on the menu. Bell eventually ditched the dogs and burgers and started a small chain called Taco Tias. He took on a business partner, and when he and the partner clashed over expanding to Los Angeles, Bell sold out and started a new chain called El Tacos. Bell again feuded with his new partners, and in 1962 he sold his share of El Tacos and started a new chain of his own: Taco Bell.

But that isn’t the most amazing thing about Glen Bell. Sure, he probably did more than any single person to make tacos and burritos popular in the United States. And sure, he started one of the largest fast food chains in America, giving his shareholders untold wealth and many a teenager a summer job.

But did you know he was related to Sherlock Holmes, too?

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For over 1,500 years, practitioners of European medicine were divided into two groups: physicians and surgeons.

Physicians were usually upper-class (or near upper-class) men who had gone to college. They dealt with a lot of abstract concepts, which led to silly ideas like the “miasma theory”, which said that diseases came from “foul odors” like sewers and cesspits rather than bacteria and viruses. They also came up with lot of wacky “cures” like bloodletting and potions and spice packets. For example, one cure for the plague involved sitting in a sewer, shaving a live chicken’s bottom and strapping it to the patient’s armpit (no, I don’t get it, either). Since they worked for a fee, it was in the physician’s interest to not irritate his rich patients. Working on commission, they often took advice from, and tailored their treatments for, their patients. It was much like a modern-day New Age quack customizing his “treatment” so that the patient would feel some amount of “improvement”. And the more dramatic and involved the treatment, the more their patients would pay for it. And because physicians had a financial interest in keeping their patients to themselves, little information was shared between doctors.

Surgeons, by contrast, were blue-collar types. In fact, for centuries they were known as “barber surgeons”, because not only did they cut hair and give shaves, they also set broken bones, lanced boils, and did many other “practical” medical procedures. Most surgeons offered their services for a set fee, although many had a “sliding scale” depending on how much the patient could afford. Unlike physicians, surgeons were under no obligation to be nice to their patients. One would just climb in the surgeon’s chair, shut up, and let him do his business. And since surgeons didn’t really have a need for secrets, most freely shared information with other surgeons.

You’ve probably noticed that medieval surgeons sound more like modern doctors than medieval physicians. And for that you can thank the French Revolution and Napoleon.

Before the Revolution, physicians had a stranglehold on most of the profitable patients in France. Surgeons, being the “lower-class bumpkins” that they were, were forced to work in hospitals for the poor, or in areas too impoverished to have an expensive physician. The surgeons were also big fans of English philosopher John Locke, whose main philosophy was sensualism, which can be summed up as “all we are is that which we experience”. Whereas physicians dealt in abstract ideas like “the miasma theory” and “the four humours”, surgeons learned from the genuine experience of dealing with patients. And since surgeons were big fans of learning and the Enlightenment, they forced their way into universities and established themselves as bona fide medical professionals. It also helped that many physicians, being upper-class or near upper-class, lost either their jobs or their heads during the Revolution. In time, surgeons greatly outnumbered physicians in France.

And then Napoleon showed up. He was the first general to amass truly huge armies. From the time of Alexander the Great until the American Revolutionary War, most armies were surprisingly small. In fact, at the height of the American Revolution, the British fielded just 56,000 troops in the United States, which is pretty tiny given the huge area of the original colonies (by comparison, the NYPD has 34,500 uniformed police officers). While many historical accounts tell exaggerated tales of battles between hundreds of thousands of men, in reality, for most of history an army of 30,000 soldiers would have been considered huge. But part of Napoleon’s strategy was mass, meaning showing up to the battlefield with an overwhelming number of soldiers. This worked, in part, because few 20,000 man armies would want to take on an army of 300,000 men. And since Napoleon relied on conscripts instead of volunteer soldiers, he had to use mass to balance out his soldiers’ inexperience.

Of course, an army of 300,000 men produces a lot of casualties. And that required a lot of doctors. In the early days, both physicians and surgeons served in Napoleon’s army. But since surgeons were much better suited to treat battlefield injuries, they came to dominate the medical establishment in France. By 1807, for instance, there were 37,000 hospital beds in the city of Paris, versus 5,000 on the entire island of Great Britain. And the large numbers of casualties led the French, out of necessity, to create specialized hospitals for fever, sexually-transmitted diseases, skin disorders, etc.

But there’s more! In the 1660s, an Englishman named John Graunt developed a statistical method for determining the population of London. Graunt wrote a book called Natural and Political Observations Made upon the Bills of Mortality, which used parish registers and other public data to not only determine the city’s population but also to determine life expectancy for the city’s denizens. His methods held great appeal to London’s shipping companies, since shipping was a risky enterprise that needed insurance to make the whole thing profitable. The patrons of a coffee house owned by Edward Lloyd soon began using similar methods to develop actuarial tables for shipping, and “Lloyd’s of London” became the world’s premiere market for all sorts for insurance.

Thanks to Napoleon and his tens of thousands of injuries, French surgeons started using methods developed by Graunt and others to analyze the mountains of data the French bureaucracy had forced upon them. And they quickly spotted important trends in the data. For example, surgeons used to prefer waiting as long as possible before amputating a limb. But the sheer volume of patients forced surgeons to work faster, and statistics showed that soldiers survived at a much higher rate when they were operated on as quickly as possible. Surgeons also used to use nicotine oil as an anesthetic for abdominal surgeries, but found that patients often died from nicotine overdoses. So they started inserting cigars into their patients’ rectums instead, which had all the benefits and few of the side effects. And the ancient art of trepanning, drilling holes in the skull to relieve pressure on the brain, fell from favor, too. Trepanning required a delicate touch and expensive equipment, both of which were in limited supply in battlefield hospitals. But surgeons noticed that soldiers who had to wait for the procedure tended to survive at higher rates than those who actually underwent the surgery.

Medicine soon became a one-way street. Input from patients was limited. You sat in the chair and did whatever the nice doctor told you to do. But there was one doctor who wasn’t entirely convinced by this approach.

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His name was Dr. Joseph Bell, and he taught at the medical school of the University of Edinburgh. Bell believed in statistics as much as anyone, but felt that statistics didn’t tell the complete story of an individual.

Bell was a keen observer, and like Shawn Spencer from Psych or Patrick Jane from The Mentalist, he often noted tiny details about his patients, things other doctors overlooked. Bell memorized the pattern of calluses on patient’s hands, for example, so he could tell a iron worker from a farmer just by looking at his hands. He noticed that soldiers had a different gait than sailors, and both walked differently than civilians. He memorized the different types of tattoo designs, and could tell if a sailor had been to Fiji versus Tahiti or Indonesia. He memorized all the subtle differences in the accents of the British Isles, and could not only tell if a person was from Edinburgh or Glasgow or Paisley or Aberdeen, he could also, thanks to the British class system, tell how wealthy they were, too. He could even tell if a man was left or right handed by how well he shaved either side of his face! Combine Bell’s various observations and he could, like a fortune teller, tell a stranger an astonishing amount about himself.

Bell had a sense of humor, too. He would begin a class by giving a long presentation about the powers of observation. Towards the end of the speech, he’d show his students a beaker containing a foul-smelling liquid.

“This, gentlemen contains a very potent drug. To the taste it is  intensely bitter. It is most offensive to the sense of smell. But I want you to test it by smell and taste; and, as I don’t ask anything of my students which I wouldn’t be willing to do myself, I will taste it before passing it round.”

He would smell the liquid, then dip his finger in the liquid and taste it. He’d pass it around, so that the students could smell and taste the foul liquid for themselves. When the last student tasted the liquid, Bell would laugh at the grimaces on everyone’s faces.

“Gentlemen, I am deeply grieved to find that not one of you has developed this power of perception, which I so often speak about; for if you watched me closely, you would have found that, while I placed my forefinger in the medicine, it was the middle finger which found its way into my mouth!”

Bell greatly impressed a student who’d arrived in 1877. His name was Arthur Ignatius Conan Doyle. And by his second year Conan Doyle had so impressed Bell that Bell made him his assistant. So Conan Doyle became intimately familiar with Bell and his powers of observation.

Conan Doyle began writing stories while in medical school. His first published story, “The Mystery of Sasassa Valley”, was featured in the September 6, 1879 edition of Chambers’s Edinburgh Journal. That same month, his first scholarly work, “Gelsemium as a Poison” was published in the British Medical Journal.

Conan Doyle finished school in 1880 and got a job as a doctor on a whaling ship called Hope of Peterhead, which sailed off the coast of Greenland. A year later he took a job as a doctor on the SS Mayumba on a voyage to West Africa. In 1882 he formed a partnership with a former classmate, George Turnavine Budd, in Plymouth. But the partnership didn’t work out, so Conan Doyle struck out on his own in Portsmouth. He arrived in town with £10 to his name (around $1,100 in modern money) and set up a practice at 1 Bush Villas in Elm Grove, Southsea.

Business was slow at first, and Conan Doyle had plenty of time to write. He wrote his first novel, The Mystery of Cloomber, at this time as well as tons of short stories. His first popular piece, “A Study in Scarlet”, was published on November 20, 1886 in Beeton’s Christmas Annual. It was the first Sherlock Holmes story, and not only did the master detective share a physical resemblance to Bell, his mental accumen did too. Conan Doyle even said as much. In a letter to Bell, he wrote:

“It is most certainly to you that I owe Sherlock Holmes… [R]ound the centre of deduction and inference and observation which I have heard you inculcate I have tried to build up a man.”

The Bell connection was obvious to others, too. Author Robert Louis Stevenson, who was on the other side of the world in Samoa at the time “A Study in Scarlet” was published, wrote to Conan Doyle and said:

“[M]y compliments on your very ingenious and very interesting adventures of Sherlock Holmes. … [C]an this be my old friend Joe Bell?”

Conan Doyle eventually grew tired of the Holmes character, and in late 1893 he wrote his “last” Holmes story, “The Final Problem”, in which Holmes and his arch-nemesis Professor Moriarty plunge to their deaths at the Reichenbach Falls in Switzerland (the Reichenbach Falls are a real place; Conan Doyle had moved to Davos, Switzerland earlier that year as a treatment for his wife’s tuberculosis). But the public demanded more Holmes stories, and Conan Doyle really liked the paychecks that Holmes gave him, so in 1901 he wrote the classic The Hound of the Baskervilles, as well as several short stories.

Bell’s observational skills weren’t only used in medicine. His great-grandfather, Benjamin Bell, was considered the first “scientific surgeon” in Scotland, and his methods were to lay the foundation for forensic science. Joseph Bell, in particular, is considered one of the founders of forensic pathology, so if you’re a fan of documentary shows like Forensic Files and American Justice, or fictionalized shows like the various CSI series, Dexter or Bones, you can thank Joseph Bell for that. And if you enjoy eating tacos or burritos while watching those shows, you can thank his descendant, Glen Bell, for that, too.

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There are a couple of interesting footnotes to this article:

It’s interesting that I should mention “restaurants” and the “French Revolution” in the same article. That’s because the French Revolution invented restaurants. Prior to 1789, French aristocrats prided themselves on hiring the best chefs for their personal kitchens. But when the revolution came, most of those aristocrats either fled the country or were beheaded, which left all those chefs unemployed. So they opened restaurants. To be sure, inns had offered food to hungry travelers for centuries, and pubs and street vendors had sold snacks and quick meals almost since the dawn of time. But the idea of a restaurant as a destination, where you would eat out of choice and not necessity, was invented in Paris in the 1790s.

Think it’s an odd coincidence that McDonald’s and (what would one day become) Taco Bell were founded only a few miles apart? Consider this: when Bell was running his first Taco Tias, he was given the opportunity to open a second location in Barstow. Since Barstow is 70 miles away, Bell didn’t think he’d be able to run both stores by himself. So he hired a young man named Ed Hackbarth to run the new Barstow location. Hackbarth later quit and started his own chain, Del Taco. Bell also convinced a man named John Galardi, who worked as a commissary manager at El Tacos, to start his own chain, which Galardi named Der Weinerschnitzel.

Remember how I said that in medieval times physicians were upper-class college men and surgeons were blue-collar tradesmen? Believe it or not, that distinction is still made in the United Kingdom, where doctors are called “doctor”, but surgeons are called “mister”. I guess that’s not entirely surprising, since a few older Brits still call nurses “sister” (because 500 years ago all nurses were nuns). To be accurate (and to keep Brits from emailing me), the senior nurse of a hospital was called “matron” and only nurses in charge of a ward or who worked in the operating room were called “sister”. However, if you watch a lot of British TV and movies it might seem like every nurse is called “sister”.

And lastly… did you know that Arthur Conan Doyle was largely responsible for the popularity of… skiing? Conan Doyle had always been an athlete. He was goalkeeper for Portsmouth Association Football Club (unrelated to the modern Portsmouth FC). He played cricket for Marylebone Cricket Club and was captain of the Crowborough Beacon Golf Club. He also enjoyed field hockey, swimming and boxing. He’d seen skiing before on a trip to Norway, where the sport had been practiced for centuries. And when he arrived in Switzerland in 1893 he thought the area would be perfect for skiing. So he sent away to Norway for some skis and met up with two locals, the Branger brothers, who were skiing enthusiasts. As hard as it might be to believe today, the brothers had taken to skiing after dark… because they were sick of being laughed at and teased by the locals for their “odd” sport! But eventually, thanks to the efforts of Conan Doyle and the Branger Brothers, the Swiss came around, and the country is now the international home of the sport. And English speakers learned about the sport almost exclusively because of the Sherlock Holmes story… so if you’re a skiing fan, you can thank Holmes and Conan Doyle for that, too!