“Statistical stratification of deaths in this parish is not my area of expertise,” I said, with a shrug. “Maybe the borough has a particularly large proportion of people in that age group.”
“My checks have taken all such factors into account by extensive use of census figures.”
“So do you feel that there is some want in the medical care in Paddington for those in more advanced years, or that there is some peculiarity to the air or the water here that makes them disproportionately prone to demise?” I then realised that Barker’s statistics were capable of quite another interpretation from that which I had initially thought he had in mind. “Or do you feel that the situation of Paddington, poor though it is, makes people live longer, so that a higher proportion of its inhabitants reach a more advanced age than is achieved elsewhere?”
“Well, that is what I am hoping you can tell us, Dr Watson,” said Dr Barker, the look of ill-humour that had been on his face since his arrival at the surgery suddenly mingled with glee. “You signed four of the death certificates.”
I half stood up at what I regarded as a slight on my patient care by Dr Barker and then sat down again. I looked at Gregson for some indication of support from him, but he stared bleakly back at me for a few seconds before he looked down at the floor.
“What are the names of deceased?” I asked at last, and my voice sounded hollow as it echoed round my consulting room.
“Their surnames were Briggs, Stratford, Higgins and Granger.”
“Briggs and Higgins I can recall,” I said. “They were quite well-to-do ladies who expired in the last outbreak of enteric fever. Stratford and Granger I do not recall. I shall have to ask my receptionist for their files.”
My receptionist was summoned, but was unable to find any files related to Stratford and Granger.
With a look of malevolence, Barker produced the death certificates. They were dated 12 March 1893 and 2 January 1894. It was unquestionably my signature on the certificates, but my mind remained blank. At a loss, I referred to the personal diary I had been keeping and this jogged my memory.
“These were not my patients,” I explained. “That is why I have no files on them. Both of these are men who expired suddenly in the surgery next door. Anstruther was called away on urgent summonses to attend to women in childbirth and his receptionist asked me to sign the death certificates. As I recall, both deaths were featureless. Next of kin were summoned to identify the bodies, which was an unpleasant task as the faces of both men bore the distorted features common in victims of death from heart-failure. I myself had no hesitation in concluding on looking at the medical notes of the deceased that Anstruther had left for me that this was the cause of death in both cases. Indeed, both men had had an appointment to see Anstruther because of weakness to the heart. Accordingly, I signed the death certificates without conducting a detailed investigation into the cause of death.”
“So there was nothing untoward about any of the four deaths?”
“Certainly not!”
“And did you benefit from the deaths?” asked Barker with a malevolent look.
I had assumed that the inquiry I was facing was into my standards of record keeping and administration. I knew these left something to be desired, as in my previous medical experience as an army doctor, record keeping had not been a primary requirement. It was only now I realised the turn this investigation was taking.
“Dr Barker! That is an outrageous suggestion. If you have an accusation to make, kindly make it directly rather than by sordid implication!”
Gregson intervened. “I think, Dr Barker, you had better leave any interrogation to the police.” He turned to me.” Dr Watson, as you will understand, Dr Barker is raising a significant matter which we will have to investigate with all the local surgeries. I would stress, Doctor, that you are not at present in any sense a suspect, but rather someone who can, in the truest sense, help us with our enquiries.” For all Gregson’s emollient tone, the menace carried by his words was unmistakable. “Dr Watson,” he continued, “can you from medical experience throw any light on why, amongst people being cremated in the Paddington area, such a high proportion are aged between fifty and sixty?”
But I had heard enough. “Gregson!” I exclaimed, rising to my feet,
“Inspector Gregson, please, Dr Watson-”
I ignored the interruption: “While I am always happy to help the police, I cannot do so when faced with vile insinuations based on statistics I have had no opportunity to validate. If you wish to charge me with an offence, please do so. Otherwise, I am not prepared to be interviewed by you unless in the presence of my solicitor.”
“Very well, Dr Watson. You will be hearing from us,” said Gregson as he and Barker left my consulting room. I closed my surgery for the day at the earliest opportunity and made straight for Baker Street.
I have quoted Holmes elsewhere as saying that he played the game for its own sake, but I felt that he pushed this objective attitude too far when his first comment at my predicament, was “How stimulating!” before hurrying on to say as an afterthought “Although obviously most disturbing for you.” We sat down in our familiar armchairs on either side of the fireplace. “Steady your nerves, good doctor, with this cigar,” he said, reaching into the coal scuttle to extract his box. “And perhaps a dash of spirits might be of assistance,” he added, pointing to the corner bookcase behind me, where bottles of whisky and brandy were perched precariously on top of a book on rubber vulcanisation. Holmes then leant back in his chair, with his fingertips resting against each other. “So these deaths were quite featureless?”
“Each death is, for the family of the deceased, a tragedy,” I said a trifle stiffly, for I felt repelled by Holmes’s apparent indifference to my plight. “But Barker was treating multiple deaths as mere statistics.”
“I shall look into the matter,” said Holmes at length. “It is still quite early,” he added looking at his watch. “If you wish to stay here while I am away, you may do so.” In an instant he was gone.
I had no desire to return either to Paddington or to Kensington, so I resolved to remain in the surroundings of Baker Street, although I knew not at what time Holmes might return. It was soothing to see the piles of documents in each corner, the Persian slipper where I knew Holmes kept his tobacco, and his unanswered correspondence, transfixed by a jack-knife at the centre of the wooden mantelpiece. The afternoon dragged, however, and at about three, I resolved to go back to Paddington and left a message for Holmes telling him where I was.
Rather to my surprise, the hour had advanced to no more than five o’clock in the evening when Holmes appeared. “I have made some progress with the case,” he said, “although the matter is far from a simple one. A will is a public document, so I went to the Public Record Office to see to whom the four people whose death certificates you signed had made bequests.”
“And?”
“You said that Stratford and Granger were Dr Anstruther’s patients and from the poorer classes of society. It is perhaps no surprise that they left no wills. Their estates, if there were any assets at all, would have been divided up according to the laws of intestacy and you demonstrably would not have benefited from these. Mrs Briggs and Mrs Higgins left wills and made no mention of you. Therefore, there is no motive for seeking their deaths that can be ascribed to you.”
“So to what do you attribute their deaths?”
“Dr Barker has undoubtedly identified a statistically significant irregularity in the number of deaths among fifty- to sixty-year-olds in the Paddington area who are then cremated. I looked at records of burials as opposed to cremations in the boroughs across London. It was noticeable that people in the fifty-to-sixty age group were slightly under-represented, but the number of burials is much larger than the number of cremations so it is not clear whether the under-representation is an insignificant devi
ation from the mean death rate, a statistical quirk, or a reflection of the higher number of people in that age group being cremated.”
“Were you able to look into any of the other deaths to which Barker referred?”
“As you might imagine, most of the deaths in an area like Paddington came from a class of people whose demise left no material documentation. In most cases, there was no will because they had not thought to make one and there were, in any case, no assets to pass down. In the few cases where I found wills, no bequest was made to any physician. If a crime has been committed, then it would appear to be quite unique in that it would be heinous in its gravity, prolific in its quantity, untraceable in its execution and motiveless in its outcome.”
“So what is there for us to do?”
“I am not sure that there is anything for us to do. There is no evidence to charge you with any offence and, from what I have seen, there is no evidence to charge anyone else with any offence either. I have no reason to think you will hear from either Gregson or Barker again. I would, nevertheless, in your position, display considerable caution in your handling of your patients who have deceased. Furthermore, I would, above all, not sign death certificates on behalf of other doctors without performing a thorough investigation of the body. I would also advocate that you focus increased attention on your administration. While there is unlikely to be a criminal investigation against you, I would not rule out the possibility of the British Council of Physicians taking an interest in your affairs.”
I thought about the chaotic state in which Holmes continued to keep the quarters I used to share with him. “You are fortunate,” I commented, “that there is no British Council of Detectives.”
“I have always maintained that I am the world’s only consulting detective,” said Holmes a little quickly. “Accordingly I have no need of a trade association to determine an acceptable level of record keeping.”
I decided to return to my living quarters in Kensington and went with Holmes to the door and down the stairs leading up from the street. We were just about to go our separate ways when Inspector Gregson and Dr Barker came round the corner.
I was unsure what to make of this and ignored their presence, but Holmes appeared anxious to engage them in discussion. “Still following your statistical friend, Gregson?” he asked.
“I have certainly been to a lot of surgeries today, Mr Holmes.” replied Gregson with a weary look on his face. “In the absence of Dr Anstruther this morning, Dr Barker wanted to visit every other surgery in Paddington, though he chose the most inconvenient route possible to get around them.”
Barker had been about to bang on Anstruther’s door, presumably in the hope that the latter had returned, but, perhaps alerted by the discussions at the foot of his stairs, Dr Anstruther himself, tall, lean and bespectacled, opened the door before Barker could knock. “Would you gentlemen like to come in?” he asked politely.
But it was Holmes who answered, saying: “It is very good to have the chance to talk to you, Dr Anstruther. We would be delighted to speak to you. Come Watson,” he said, turning to me, “I would not wish to continue this investigation without my Boswell.”
I don’t think Barker and Gregson had anticipated that Holmes and I would join them in their investigation of Paddington’s doctors, but Gregson made no move to stop us. The four of us went through the bare and gloomy hallway of Anstruther’s house into an equally Spartan consulting room. Barker made the same sorts of accusatory remarks to Anstruther as he had made to me. My neighbour had signed no fewer than twelve of the death certificates of the people whose deaths Barker regarded as suspicious.
“And what is the nature of your concern, Dr Barker?” asked Anstruther, leaning back in his chair and apparently displaying none of the outrage that I had felt when Barker had made his accusations to me. “You appear to have nothing of substance.” He paused to light a cigarette and bluish-grey puffs of smoke rose lazily into the air around him. “You have found a statistical anomaly, but statistics throw up anomalies all the time and the sorts of population sizes you are talking about are barely significant.”
I could see Barker redden under his beard at Anstruther’s dismissive response and the latter pressed home his advantage:
“You have no body that will betray any symptoms of foul play since all the deaths you regard with such concern have resulted in cremations. Given that my patients were of modest means, you cannot claim I have benefitted from their deaths. The statistics may indicate an abnormality, but I can assure you that there was none in any of the cases under investigation. Why, I even let a fellow doctor, the good Watson here, sign off the death certificates of two of my patients, which I would surely not do if there were anything untoward about the deaths. Dr Barker, you are surely not accusing me of eliminating these people for the sheer pleasure of-” he paused as he sought a suitable expression, “-terminating their existence?”
There was something slightly repellent and at the same time impenetrable about my neighbour’s serenity as he repeated the same arguments that Holmes had used to suggest there was no case to answer. As though reading my thoughts, Dr Anstruther leant back in his chair. “I have no case to answer, no case to answer-” he leant forward and stubbed out his still-glowing cigarette in the ashtray before him, “-at all.”
A few minutes later we found ourselves on the street - Barker fulminating at Gregson that nothing of substance had been achieved that day - before we went our separate ways.
The next morning, I determined to ignore the events of the previous day and went to my practice early to try and remedy some of the administrative deficiencies to which my attention had been drawn. It was when I was due to see my first patient at nine o’clock that my receptionist came in to ask if I could take Anstruther’s patients for the day.
“Is he away again?” I asked wearily.
“No, Doctor Watson,” she replied. “He was knocked over and killed by a milk cart early this morning as he was going to get his newspaper.”
I could hardly close my surgery for a second successive day under these circumstances, but my attempts to minister to patients were soon interrupted by the arrival of Gregson, Barker and Holmes.
Gregson explained for my benefit that Anstruther had stepped out into the road without looking and been struck down by a heavily laden carriage pulled by Shire horses. Death had been instantaneous.
“I wonder if the death was an accident, or whether he killed himself after yesterday’s barely concealed accusations from Dr Barker. He struck me as being very far from the type who would shy from combat,” mused Holmes. “Anstruther had a lifestyle out of keeping with the income from his practice and yet we have no evidence that this had anything to do with the high level of deaths at his practice.”
“We need to refer to medical experts here,” I opined. “I think we should go to the British Council of Physicians in Grantly Square to take advantage of their expertise.”
Dr Antony-Ball, Head of the Council, was known as a fierce defender of members’ interests. I doubt that he could have been prevailed upon to see me on my own, but the name of Holmes on a visiting card had the characteristic effect of persuading a man in authority to grant us an interview. I gave Dr Antony-Ball a summary of events with assistance from Holmes, Barker and Gregson.
“Dr Watson,” responded Antony-Ball, “your line of enquiry seems directed towards denigrating a fellow doctor who, due to today’s tragic events, can no longer defend himself. I can only speculate as to your motives, but the hope of getting your former neighbour’s patients by default is a plausible one. The Council takes very seriously the need for our members to have administrative procedures that are beyond reproach. And by your own admission, you have signed a death certificate on behalf of another doctor apparently without making any serious effort to investigate the cause of death.”
For a second time in two
days, my voice seemed to have a hollow ring to it as I felt I was being cast in the role of the accused when my role was that of a witness. “I did not come here to discuss the shortcomings of my own practice. I came here to express my concerns about a neighbouring practice.”
“From what you say, there is nothing to investigate in your neighbouring practice. There is no admission there of administrative shortcomings and none will be forthcoming, given Dr Anstruther’s sudden demise. Dr Watson, you have come here as a baseless accuser, where it is in fact you whose working methods will require a full investigation from the Council. And you, Dr Barker,” he said, turning to my first accuser, “have done the medical world no service by your investigations based on statistical analysis. Your ill-conceived conjectures have risked creating a wave of general unease around Paddington about the standard of medical care being provided when it is the interests and wellbeing of the individual patient that are paramount. Dr Watson, we will perform a full review into your administrative procedures. I can at this stage exclude no sanction. And you, Dr Barker, if you continue to ventilate these unfounded rumours against fellow doctors, your right to practise medicine will be withdrawn.”
The review of my practice’s administration was launched immediately and with the minimum of discretion. It soon became something of a cause célèbre in Paddington. My patients rapidly found other medical surgeries to meet their medical needs. It was soul-destroying to see the business I had worked so hard to build up, leach away. In “The Norwood Builder” I commented that Holmes found money for a young relative of his, Verner, to buy my practice in the very first few months following his return, although I only became aware of his generosity after the event. My reader may have wondered how Holmes, who had not been earning major sums during his three-year absence from London, was able to fund such a purchase. In fact, there was very little money to find as, in the end, I was forced to sell the business at the written-down value of its assets with no goodwill at all. The subsequent loss of my practising certificate came only after this and was of little financial consequence to me as I had already thrown my lot in with Holmes. It was, nevertheless, a major blow to my self-esteem. Meanwhile, the Society for Life Assurances reviewed its business model and decided it no longer needed a full-time medical officer as it could get medical advice on an ad hoc basis from a panel of contracted doctors. Other actuaries subsequently made the same decision and Dr Barker was unable to get anyone to employ him.
The Redacted Sherlock Holmes, Volume 3 Page 2
