NOTES: Imbecile: correct medical term of time period to describe the mentally impaired.
Written for my first year seminar class,"the analytical methods of sherlock holmes" at wake forest university. Hope you like! Pam
The Psychologist's Patient
When I look back on Holmes's prolific case histories, sometimes I cannot help but think we never should have meddled. Either there was no wrongdoing or Sherlock dealt justice in his own peculiar way that was fairer than any English court by his silence. This particular case came our way from the most shocking medical surgery I had ever seen. Yet, it was one of those heart-rending stories that reaffirmed my beliefs in humanity after crimes such as Black Peter and the Sign of Four.
I was enjoying one of my last evenings as a free bachelor gazing out into the bustling quiet of the street below. I was to be married within a fortnight and no man could be happier. My heart was carried away forever with my Mary and I could only hope when we finally began our lives together I would be able to make her as happy as she has made me.
The bell rang rather rudely and the image of my smiling Mary disappeared from my mind like soft petals caught in a swift wind. So much for my dreaming. Few of my acquaintances would call at such an hour, so I supposed our visitor might be yet another lost soul seeking repose in his haunted existence.
For once the client did not come alone. Mrs. Hudson let in a thin elderly gentleman and a bent over adolescent boy with a stock of fair hair who walked with flat feet turned inward. There was nothing remarkable about the gentleman. He wore a plain starched shirt with ink-stained cuffs beneath a tan linen jacket. He had the bearing of an efficient society figure but the kindly look in his eyes betrayed a compassionate and worrying nature.
The boy he kept close at his side was clearly an imbecile. His wide eyes rolled in his head looking at everything but remembering nothing. His fixed childish smile seemed strange on an older face, but one couldn't help but feel pity for one so helpless. It was through no fault of his that he was made to carry such a burden.
"Hello, I am Dr. Watson. How may I help you?"
"Good day, my name is Dr. Warner and this is my patient Harold Cole. We are here to seek the advice of Mr. Sherlock Holmes and yourself, if you don't mind. Mrs. Cecil Forrester told me of his immense powers of solving curiosities as well as your extensive medical knowledge."
This was recited impatiently by a man accustomed more to listening to the misfortunes of others than expressing his own. It was clear he was agitated by some terrible occurrence concerning his patient when he draped a protective arm over his companion's shoulders. In response, Harold looked at his caretaker with sad yet confused eyes cocking his head to one side, incomprehensible of the situation.
"At the moment, Mr. Holmes is away on business but will return shortly. You are welcome to stay and –."
At this moment there was a small commotion at the door as Holmes entered the room with several wrapped packages smelling faintly of iron and sulfur.
"Why hello, I'm Sherlock Holmes, and I'll be with you just as soon I set these down."
Meanwhile, the boy had suddenly become very excited. He started making impatient moans and started looking eagerly over the room hoping to find something. He would have followed Holmes into his laboratory had the doctor not held him back so forcibly. Harold's efforts only ceased when Holmes returned and sad disappointment overcame him.
"Pray take a seat, you must surely be tried from your long journey, doctor," said Holmes cordially with his eyes glinting anxiously as he offered the doctor a stuffed armchair and the boy the lounge chaise facing the window.
"In my profession, I value patient discretion quite highly. Am I able to trust you and Dr. Watson to keep secret what I am about to say?"
"You have our confidence, not a word will be repeated unless required to do so."
"Very well."
"Please begin your story from the very beginning with all details."
"I am one of the committee members that manages the Guildford Psychiatric Asylum for the Mentally Disabled. It is a privileged institution that prides itself on the best patient care and privacy. I am, myself, a psychologist, a specialist of mentally disabled children. I usually see my patients privately once a week to assess their progress and make sure they are doing well. Harold Cole has been my patient for only this past year. His previous doctor passed away from old age. From his records, he entered the institution at the age of eight and has lived there exclusively since then. His family felt they could no longer care for him without taking away his freedom and causing embarrassment to themselves. He is now seventeen years old. He was not born as you see him. At three years of age, he suffered from scarlet fever and never quite recovered. It took his mind and what little speech he had learned. As you can see he has the mental acuity of a small child. Not only that, he has a growing tumor in his neck near the carotid arteries. We are not sure if it is cancerous, but I fear for the worst. From my experience, children with disabilities and childhood illnesses rarely survive into adulthood despite all efforts.
"Harold cannot recall events clearly nor express himself with words, although he can understand simple words and meanings. He can remember people he sees regularly, such as me and the nurses at the institution. Unlike the other children however I've noticed, he does not become frustrated or throw temper tantrums. Psychologically speaking, I do not know why. But I believe Harold understands more than he lets on. He somehow, despite his retardation, understands his restraints. Instead of rebelling against themselves as all children do, Harold always tries to do whatever he can to progress even though he knows the letters he learned today will be forgotten the next day. Not only that, I believe Harold feels rather ashamed of his disabilities. But I do not believe he is driven by shame. No, I believe that he is more like a child, who cannot comprehend the darker shades of motivation. When he knows there is something he can do, he does it. He doesn't want to be in anyone's way. He knows he is, but tries his best to help others in his own selfless way.
"It is because of this, I believe we are here today. Our mystery has already been dismissed by the local police and doctors as a trivial matter. Something to me simply didn't feel quite right.
"Two weeks ago, the twenty-third of August, Harold disappeared and reappeared ten days later. Of course there was a full investigation. On the twenty-third of August, Harold was last seen in the playground at two P.M. His usual routine is breakfast at seven, classes with a lunch break from eight to two, then recreation such as outdoor games, with the other patients in the pediatric department until dinner at seven. He is to be in bed by nine in the evening. For the protection of the children, they are collectively overseen by two experienced nurses at a time. His absence was immediately noticed and staff went about the grounds looking for him. No trace of him could be found. The police were called and a blockade of the main road was set up and a group search of the immediate vicinity done. The searched extended into the city but was still unsuccessful. At the time, I was away attending the Annual Psychology Conference in Dover.
"Then just as suddenly as he had disappeared, on the very early morning of September second, he appeared at the institution's gates. No one could account for how he had reappeared. He wore the same attire he disappeared in. He was well-fed and clean. No difference could be ascertained besides the scar. It was only at the end of the day when a nurse went to bathe him that a previously nonexistent scar on his left side was finally noticed. Allow me to show you. It's not very obvious, I'm afraid."
Dr. Warner went over to his patient and made him pull up his shirt to expose the fleshy torso and made him lie on this right side on the couch. True enough, there was a scar on the boy's left side that followed the edge of the lowest rib slanting towards the midline. It was perhaps six inches in length and as thin as a shoelace. The cut had healed long ago and all that was left was a pink colored scar. By looking at the remaining scar, the initial cut was probably a superficial cut that had been well taken care of. It did not look out of the ordinary for an adolescent child to get scrapes or bruises.
"May I examine him, Dr. Warner?" asked Sherlock.
"Yes, of course, that is why I bought him. And if you wouldn't mind Dr. Watson, I would prefer another medical opinion."
We crowded over the boy who seemed neither frightened nor amused. He had no doubt undergone several examinations of this kind already. Holmes took out his magnifying glass and began his meticulous scrutiny of the entire body, especially the boy's hands and mouth. He was like a violin luthier examining every curved piece trying to pick up every imperfection. The boy took to Sherlock uneasily at first until Sherlock offered him a piece of chocolate. Holmes was so absorbed in his work, taking tissue samples or something with forceps, that he did not notice the boy pick up his gold snuffbox with the large jewel in the center and gaze mesmerized at its workmanship and beauty.
"I am no medical doctor," continued the doctor, "but the medical examinations completely by the police and institution doctors were unanimous: the scar came from a minor cut. Harold himself has already been interrogated many times and he cannot remember anything nor give any indication of anything. The police concluded and ultimately reported that Harold left and returned to the institution of his own accord with a minor cut.
"From beginning to end, the small Guilford police could make nothing of it. They have evidently dismissed the case as normality among mental institutions. Despite our efforts, one or two patients of the adult ward annually escape. Since Guildford is immediately outside of south London, those patients are rarely seen again, but children have always been a different matter. No child has ever escaped; they prefer our quiet institution to the city's chaos.
"Several points simply do not fit. As Harold's doctor, I know he wouldn't leave the institution; he is far too attached to it. He usually abhors strangers. No psychological change, as far as I can tell, has come over him. And yet, there is that scar. I don't care what those doctors say, that scar simply isn't typical. What am I supposed to do? I can't just ignore –."
"Ah-choo!" Harold sneezed.
He had finally spilled the snuffbox sending up a small plume of particles. But sneezing obviously pained him greatly. He clutched at his scar and started gasping for air. Tears came to his eyes as he looked imploringly towards his doctor for help. The doctor opened windows and called for a glass of water. When none of our efforts worked, Holmes went quickly into his laboratory and came back with a syringe.
"With your permission Doctor, may I give him an analgesic pain killer? This is weak opium-derivative codeine," asked Holmes.
The psychologist looked at me questionably.
"Why does he need a pain killer when he's showing asthmatic symptoms?" I asked, alarmed that Holmes would use his own evil medications on an innocent boy.
"Because he isn't showing asthmatic symptoms. I'll answer your questions after I take care of this," Holmes replied as he expertly injected the boy in the arm.
After the medication had calmed the boy down, Holmes said, "Now, I have some questions for you, doctor. Does Harold have any visitors?"
"I have never met his parents, but apparently they visited him occasionally when he was young but have not done so in the last few years. I believed the father died in an accident and his wife followed soon after of some terminal illness. Harold only has a married sister who visits him on the holidays and his birthday. She is the only one. And she takes care of his costs."
"And in the time before Harold disappeared, what was his overall health?"
"As I said before he has a tumor that may someday constrict his breathing, but bodily he is fine. He is able to exercise and recover from colds and such like any other child his age. Currently he is doing well."
"That's all, thank you doctor," said Holmes with his brows knitted, "You may not be ready to hear this, but this is not just a kidnapping; no simple manipulation of Harold's good nature, as you suspected. It is a far more serious crime: Harold is missing his left kidney."
The impact of Holmes's conclusion was momentous. How could such a thing happen? Why would anyone remove a kidney? I looked at the same patient and saw no signs of major invasive surgery.
"Preposterous! Inconceivable! W—why it's just impossible! For one thing, it's not even possible!" cried Dr. Warner.
"Wrong. When you have eliminated all which is impossible, then whatever remains, however improbable, must be the truth. Do you see here with the magnifying glass doctor, the remains of some white filament in the scar? I have studied fabric thread intensively. It is one of the best indications of past locations. Threads cling to everything and are not easily gotten rid of. What you see is the remains of white silk."
Holmes showed the doctor a piece he had removed earlier. It looked no bigger than a dandelion seed, perfectly straight and white.
"The only thread that can withstand regular bathing and still remain relatively straight, unchanged, and strong is silk. Cotton or linen threads crumple or fray under such conditions which is why silk is ideal for medical sutures. We are lucky the stitches were removed by cutting one end of the stitch then removed all at once or we wouldn't have such evidence. Once again the scarlet thread in the colorless skein of life has appeared but white this time."
"But that's still impossible! Suturing is always done with an interrupted stitch, you would be able to see the scars of the needle marks," I said.
"That," said Holmes "is the beauty of this case, doctors. If you have studied surgery, as I have, this surgery was not executed by a regular surgeon, but by an experienced surgeon well versed in reconstructive techniques, 'plastic surgery' as it has come to be called. Quite an uncharted field of medicine, though. There are needle marks, but there are only two. In the interrupted stitch, where the curved needle enters the skin perpendicularly and makes a semicircle under the skin through the incision and over the incision to the other side again, you would see two lines of dotted needle marks parallel to the incision. Yet there are only two needle marks, nearly invisible. This is the classic plastic surgeon's subcuticular suture technique. Instead of using a curved needle, a straight needle is inserted at the apex of the incision and run through the dermis of the skin. The suture was completed under the skin, but the needle ends went through the epidermis so the suturing thread could be removed when the incision healed. So you only see two small needle marks. A cosmetic effect, really. I've never seen a better suture."
There were indeed two very small needle marks at either end of the scar now that Holmes pointed them out, but barely visible than to be mistaken for normal skin pigmentations. The skin was perfectly flush on both sides. Usually on large surgical sutures you see kinks in the skin, yet there was none here. It had been an absolutely perfect stitch. How strange that an educated surgeon would remove a kidney from a mentally retarded child and take great pains to hide it. What purpose could have motivated this blatant violation of medicine's noble purposes?
"But how did you know the kidney was taken?" I asked.
"That was obvious; the only organ located beneath Harold's incision is the kidney. One can still live on a single kidney and Harold is still clearly alive. My suspicions were confirmed when he sneezed from the snuff. When the kidney was removed renal arteries and nerves had to have been severed. These nerves are proximal to the diaphragm. So while is he still healing, heavy breathing of any sort is rather painful. That is why he needed the codeine."
There was no hint of triumph or accomplishment on Sherlock's face after such an explanation. I interpreted only the same feeling we all felt: shock and disgust that such a thing could happen. The psychologist had slumped into a chair and looked terribly agitated that the situation was more sinister than he had ever expected.
"Who—who would commit such an atrocity?" he asked.
After some time, Holmes replied, "someone who was desperate. As Horatio Nelson once said, 'Desperate affairs require desperate measure.' You had better leave this matter in my hands for now. I promise you I will find who did this to your patient. At the moment I think you had better take Harold back to the institution and make sure he is well rested. Also it would be wise not to tell anyone about this."