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December 19, 1977

Holmes or Spade?

JAMA. 1977;238(25):2721-2722. doi:10.1001/jama.1977.03280260051020

To the patient, an illness is a dramatic, often tragic chapter in a long autobiography. To the diagnostician, however, it is primarily a mystery story in which he is the detective. As such, he may wish to draw some parallels from the behavior of his counterpart, the professional sleuth of popular fiction.

In a recent essay, the master dichotomist C. P. Snow1 classified detective stories into two species, the classical and the romantic. In the former, the detective solves his problem by deductions based on observation and logic, much as the scientist solves his by the scientific process. Curious, observant, and impeccably logical, he does not indulge in psychological analysis, nor does he display any emotional involvement, let alone righteous indignation. His satisfaction, as well as that of the reader, comes from solving a mystery, from bringing order into a disorderly situation.

This type of detective was predominant in the