Rested, if not completely refreshed, we could be found the next morning up with the lark. My wife was courteous towards Holmes, although I received a reception so frosty that even an Eskimo would feel the chill.
It was a relief to make our exit into a thankfully dry morning. My head clearer than it had been for days, I decided to drive, pleased to take the wheel once again. As soon as we were entrenched in Queen Anne Street, I started consulting my books, looking for an expert in the rare condition Holmes had uncovered. We were in luck, and before the hour was out, were sitting in the consulting room of Dr Gapton of Harley Place, the country’s leading authority on Myositis ossificans progressiva. He was a thin fellow, dressed smartly in a stiff collar and tie, with the look of a man who spends too long in the library and not enough in the sun. I must admit that seeing him did bring a shudder, as his pallid complexion awoke memories of the encounter with our unnatural assailant at Abberton Hospital.
I described the bone that had been taken, and Gapton nodded, inviting us into an adjacent room. It contained a library of medical tomes and, most strikingly, a full human skeleton, but one unlike any I had ever seen.
“This fellow suffered from M.O.P.,” Gapton said, stepping aside to let us take a closer look. “I treated him myself and when he died he left his body to medical science.”
The specimen was ghoulishly fascinating, and I had to remind myself to treat these human remains, like others, with the respect they deserved. The skeleton, hung in the traditional way, was twisted, its bone structure smothered in the same growths as we had seen on the clavicle. However, the mutation itself was more advanced. Where there should have been ribs, a gnarled armour plate was grafted to the contorted frame, while the jaw of the skull was similarly fused together. He must only have been able to take soup through a straw. Chewing would have been impossible.
“This is appalling,” I said. “His life must have been unbearable.”
“The condition is debilitating, yes, although, as I’m sure you must have discovered over the years, Dr Watson, the human spirit is more resilient than the flesh it inhabits. The men and women I treat, why, they are some of the bravest souls you could ever meet.”
“Is there a cure?” Holmes asked, his voice impassive as always.
Gapton showed us back into his main consulting room. “I’m afraid not, which is the tragedy, especially as, in most cases, the condition first manifests in infancy.”
“At what age?” I asked, taking my seat.
“I’ve seen children as young as five years old. Symptoms often appear following a trauma, a fall or some such.” Gapton fetched a book from a shelf and joined us, sitting behind his desk. “There have been mentions of the disease since the late 1600s, although the first clear description was made by John Freke of the Royal Society nearly two hundred years ago.” The doctor found the appropriate passage in his book and offered it to me. I skimmed the page, finding a passage dated the fourteenth of April 1740. I read it aloud to Holmes.
“There came a boy of healthy look and fourteen years of age, to ask of us at The Hospital, what should be done to cure him of many large swellings on his back which began about three years since, and have continued to grow as large on many parts as a penny-loaf – Good Lord – particularly on the left side. They arise from all the vertebrae of the neck, and reach down to the os sacrum.” I looked up from the book to offer Holmes an explanation. “That’s a triangular bone at the base of the spine, part of the—”
“Pelvis, yes, I know,” Holmes interrupted.
“Very well. They likewise arise from every rib of his body, and joining together in all parts of his back, as the ramifications of coral do, they make, as it were, a fixed bony pair of bodice.”
“It’s as good a description as any that has been offered since,” Gapton commented.
I nodded, recalling the misshapen skeleton in the other room.
“Two hundred years and we are no nearer a cure,” I commented.
“Not for want of trying, I assure you.”
I raised an appeasing hand. “It was no criticism, Doctor. I often feel that while we have achieved so much in the last century, performing medical feats that would once have had us either praised as miracle-workers or condemned as witches—”
“There is still much that we do not know, or seem able to combat. I agree, which is why I have dedicated my life to this particular curse.” He gave Sherlock Holmes a good-natured smile. “You have your mysteries to solve, this is mine.”
“An admirable attitude, Doctor,” said Holmes. “So, these swellings; they are the first symptom?”
“Usually, although there are other indicators that a child may suffer from M.O.P.”
“Such as?”
I jumped in, still consulting Gapton’s book. “There’s mention in this report of an abnormality in the toes.”
“The toes?” echoed Holmes.
“Yes,” replied Gapton. “Sufferers are often born with malformation of the great toe.”
“It is stunted?” Holmes asked.
“Why, yes,” Gapton responded. “With a valgus deformity.”
“Meaning that the bone is twisted away from the body slightly.”
“Quite so. The greater the deformity—”
“The greater the severity of the condition.”
“I see you’ve been doing research of your own.”
“So, every time that the child is injured…” Holmes prompted, ignoring the suggestion.
“The condition goes to work,” Gapton replied. “Normally, the immune system rids us of infection, while broken bones knit back together, but with M.O.P., the body’s response is amplified. The muscle itself ossifies, encasing the original skeleton at the point of injury.”
“And the extraneous bone cannot be removed?” I asked.
Gapton shook his head. “Not without more growth. It’s a vicious circle. Before long the patient’s joints seize up, leaving him with restricted movement at best.”
“And at worst?”
“Complete immobility.”
Holmes leant back in his chair, considering his next question.
“How many patients are you currently treating, Doctor?”
“Well, as you know, the condition is thankfully extremely rare, although I do have one on-going case, here in London.”
“Would we be able to interview your patient?”
Gapton looked uncomfortable at the suggestion. “That might not be possible, Mr Holmes. The family in question values their privacy, and are wary of their son becoming a curiosity.”
“It is a boy then?”
The doctor’s expression darkened. “Why do I have the impression that I’m being interrogated? I welcomed you into my surgery as I believed you were interested in my work, not my patients.”
“We are interested in both,” I cut in. “The case we are investigating is of national importance.” For all I knew, my claim was not a complete lie. The fact that everyone had turned us away, from the Metropolitan Police to Holmes’s own brother, suggested that we had stumbled upon something of political import. “If we can understand this terrible condition, then we may be able to find a connection.”
“Between your case and the bone you discovered.”
“Exactly. Dr Gapton, as one doctor to another…”
The doctor examined my face before coming to a conclusion. “Very well. I shall contact the family and see if they will meet with you, but if they want to keep out of whatever this is – and I warn you, I suspect they will – then I shall have to respect their wishes. As a doctor, I am sure you understand the importance of the Hippocratic Oath.”
“Whatever I may happen to obtain knowledge of, if it be not proper to repeat it—”
“—I will keep sacred and secret within my own breast,” Gapton finished.
Handing back his book, I assured the doctor that we quite understood. Holmes himself apologised for any offence and thanked Dr Gapton from the bottom of his heart.
After a congenial farewell, we retired to my practice to await Dr Gapton’s verdict. As Holmes perused my library for mentions of the abominable disease, I had a question of my own.
“Holmes, how did you know about the toes?”
“What’s that, Watson?”
“When Gapton was describing the symptoms you knew about the irregularity of the toes before he mentioned it. What was it? Something you noticed on the skeleton?”
Holmes smiled, returning his attention to the book in his lap. “Not at all, Watson. I was merely thinking back to the footprint we found in the operating theatre.”
“The one in the blood? The woman’s?”
Holmes nodded. “Quite so. I am surprised you failed to notice yourself, Watson. Her toe was stunted.”