Dr Watson laid aside his diary and read out aloud what he had written to himself to confirm that everything was as he had remembered of the case.
On glancing over my notes of the seventy odd cases in which I have during the last eight years studied the methods of my friend Sherlock Holmes, I find many tragic, some comic, a large number merely strange, but none commonplace; for, working as he did rather for the love of his art than for the acquirement of wealth, he refused to associate himself with any investigation which did not tend towards the unusual, and even the fantastic. Of all these varied cases, however, I cannot recall any which presented more singular features than "The Case of the Nun's Disease".
It all began in a year, and even in a decade, that shall be nameless, that upon one Tuesday morning in autumn I woke to find Sherlock Holmes standing, fully dressed, by the side of my bed. He was a late riser, as a rule, and as the clock on the mantelpiece showed me that it was only a quarter-past seven, I blinked up at him in some surprise, and perhaps just a little resentment, for I was myself regular in my habits.
"Very sorry to knock you up, Watson," said he, "but it's the common lot this morning. Mrs. Hudson has been knocked up, she retorted upon me, and I on you."
"What is it, then -- a fire?"
"No; a client. It seems that a young lady has arrived in a considerable state of excitement, who insists upon seeing me. She is waiting now in the sitting room. Now, when young ladies wander about the metropolis at this hour of the morning, and knock sleepy people up out of their beds, I presume that it is something very pressing which they have to communicate. Should it prove to be an interesting case, you would, I am sure, wish to follow it from the outset. I thought, at any rate, that I should call you and give you the chance."
"My dear fellow, I would not miss it for anything."
I had no keener pleasure than in following Holmes in his professional investigations, and in admiring the rapid deductions, as swift as intuitions, and yet always founded on a logical basis with which he unravelled the problems which were submitted to him. I rapidly threw on my clothes and was ready in a few minutes to accompany my friend down to the sitting room. A lady dressed in black and heavily veiled, who had been sitting in the window, rose as we entered.
"Good-morning, madam," said Holmes cheerily. "My name is Sherlock Holmes. This is my intimate friend and associate, Dr. Watson, before whom you can speak as freely as before myself. Ha! I am glad to see that Mrs. Hudson has had the good sense to light the fire. Pray draw up to it, and I shall order you a cup of hot coffee, for I observe that you are shivering."
"lt is not cold which makes me shiver," said the woman in a low voice, changing her seat as requested.
"What, then?"
"It is fear, Mr. Holmes. It is terror." She raised her veil as she spoke, and we could see that she was indeed in a pitiable state of agitation, her face all drawn and grey, with restless frightened eyes, like those of some hunted animal. Her features and figure were those of a woman of thirty, but her hair was shot with premature grey, and her expression was weary and haggard.
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| Miss Miles explains why she needs the help of Mr Holmes.
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Sherlock Holmes ran her over with one of his quick, all-comprehensive glances.
"You must not fear," said he soothingly, bending forward and patting her forearm. "We shall soon set matters right, I have
no doubt. You have come in by train this morning, I see."
"You know me, then?"
"No, but I observe the second half of a return ticket in the palm of your left glove. You must have started early, and yet
you had a good drive in a dog-cart, along heavy roads, before you reached the station."
The lady gave a violent start and stared in bewilderment at my companion.
"There is no mystery, my dear madam," said he, smiling. "The left arm of your jacket is spattered with mud in no less than seven places. The marks are perfectly fresh. There is no vehicle save a dog-cart which throws up mud in that way, and then only when you sit on the left-hand side of the driver."
"Whatever your reasons may be, you are perfectly correct," said she. "My aunt's faith in your deductive powers is well founded I can see," says she. "I am here on a matter of life and death. Alas!" said she, "the very horror of the situation lies in the fact that my fears are so vague, and my suspicions depend so entirely upon small points, which might seem trivial to another, that even those to whom of all others I have a right to look for help and advice looks upon all that I tell as the fancies of a nervous woman. But I have heard Mr. Holmes that you can see deeply into the manifold wickedness of the human heart. You may advise me how to walk amid the dangers which encompass those who share the horrors of which I am about to speak."
"I am all attention, madam." says he.
"My name is Sarah Miles, and I am here on behalf of my aunt. She is dying Mr Holmes. She is dying of a dreadful illness that has plagued those of her vocation. She has sent me to you for even though she lies bedridden in terrible pain, knowing that her time is short. But even in this state, her mind is clear and she has heard of you and knows in her heart that if anybody could solve the riddle of her illness, you can. But knowing that she has but a few days to live, perhaps a week or two at the most, it is the reason why I have hastened here at such an early hour. She wants to know if you can help before she dies and the reason for my haste"
"Prey tell me what vocation is that", said he, his eyes now aflame with interest.
I am sure I detected a tear in the corner of his eye, as I glanced over to him.
"She is a nun Mr Holmes", says she. "and has returned home with me to die" But she is not alone in her agony for many in her convent had died of the same disease, and others.
"Ah yes, says he. "You mean that she has the nun's disease, which nowadays is called breast cancer? I have heard much about this terrible disease"
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| Holmes consoles Miss Miles as she relates the condition of her Aunt to him.
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Holmes glanced in my direction. I had expected him to be impatient upon this narrative because of the untypical nature of the case, one that my profession is more likely to be involved in than he, but, on the contrary he had listened with the greatest concentration of attention.
"Yes Mr Holmes, she has that terrible disease, that spreads fear and tribulation among all women, but especially nuns, who for reasons yet unexplained, are susceptible to its horrors. My aunt knows that there is nothing that anyone can do for her, but she believes that if anyone can find out why those of her calling get the disease, it would be you sir.
She turned in my direction and asked, "Dr Watson, are you a doctor of the medical profession."
"Yes, I replied", knowing what she was about to say.
"Why is it Dr Watson that those who are supposed to find out cures and remedies for sickness and disease have failed so badly when it come to this disease", says she. "Instead all that seems to be done is to offer treatment when someone has the disease, which often results in painful mastectomy which rarely resolves the problem."
"Madam", says I. "We of my profession do not know why nun's are more prone to get the disease than other women". All we have are a few pointers, but not enough to ascertain the reasons why. So all we can do is tackle the disease when it arises, hopefully when it is caught in its early stages, because if we do, we can usually provide treatment that will either cure the person or at least extend the life of the patient."
"Yes Dr Watson", says she. "What you say is true but this is no comfort for a women if she has to wait to find out if she contracts this terrible disease before any treatment is given her and by which time it is already too late. That is why my Aunt believes that someone like Mr Holmes, the famous detective who solves cases of crime when all others have failed, may best be qualified to find the answer."
Turning to Holmes, the lady hesitated, but then asked, "Sir, if anybody can fathom out the answer to this riddle my Aunt believes that you can. Please Mr Holmes, she requests your help in this matter, for the pointers that your colleague speaks, are clues like any that you have used in solving crimes. Surely Mr Holmes", says she. "There is no difference between these and those clues you have acted upon in the crimes that you have solved".
I could see that Holmes was moved by the manner and speech of Miss Miles. For a moment I could see this from the expression on his face, one that I was familiar, when he was in deep thought. Then his face changed to one of an expression of gentleness and conviction.
"Miss Miles" he says. "You are quite right in what you say. Tell your Aunt that I will endeavour to provide an answer to her enquiry before she takes that journey that we all must take one day. She has my deepest sympathy and respect".
Miss Miles arose, tears in her eyes and thanked Holmes for his words of encouragement. Mrs Hudson escorted her to the door and hailed a cab for the young lady and she departed.
The Game is Afoot
When our visitor had departed Holmes stood in silence then sat for some time lost in the deepest thought. Unable to bear the suspense anymore I caught his attention, which only made him frown.
"Holmes, what are you going to do, then?" I asked.
"To smoke," he answered. "It is quite a three pipe problem, and I beg that you won't speak to me for fifty minutes."
He curled himself up in his chair, with his thin knees drawn up to his hawk-like nose, and there he sat with his eyes closed and his black clay pipe thrusting out like the bill of some strange bird. I had come to the conclusion that he had dropped asleep, and indeed was nodding myself, when he suddenly sprang out of his chair with the gesture of a man who has made up his mind and put his pipe down upon the mantelpiece.
"Watson, my good fellow", says he to me. "Tell me what you know about this disease."
"Holmes", I replied. "There is really very little to tell. Breast cancer as it is now called, first made its appearance in the seventeenth century, although it is suggested that it may have occurred before then. At that time it was known as the nun's disease because for reasons unknown it was particularly prevalent amongst nuns. Bernardino Ramazzini an Italian physician was the first to notice this unusual trend in the convents, when he was carrying out a survey of convents to look at the occupation."
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| Holmes thinks about the case in silence
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"Ah!" Holmes exclaimed. "I have heard of this man. He was a man after my own heart and he used similar methods as I, in identifying causes and effect for various illnesses. If I recall his book "Diseases of Workers" outlined the health hazards of chemicals, dust, metals, and other agents encountered by workers in various occupations. He had seen that there was a relationship between various metals and the symptoms of metallic poisoning that developed in the artisans who worked with them, and he recognised that paints were a factor in the poisoning of painters. He also made studies of diseases in other occupations including lung diseases of miners, eye conditions of printers, and yes, I remember now, "breast cancer in nuns." Watson, what conclusions did he reach with respects to our present case?
"Well, my friend", says I. "It was a puzzle to be sure. The only thing he could think of was that perhaps there was some relationship between their celibacy and childlessness. "
"No Watson!" says he. "There must be more that this for even now many women remain childless and do not suffer from the disease. What else do you know?
"There is strong evidence that breast feeding offers some kind of prevention to women getting the disease." I said. Medical studies have shown this to be true, and nuns of course did not breast feed, so this must be of some relevance."
Sherlock Holmes clapped his hands softly together and chuckled. "Pon my word, Watson, you are coming along wonderfully. You have really done very well indeed. It is true that you have missed everything of importance, but you have hit upon the method" Never trust to general impressions, my boy, but concentrate yourself upon details.
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| Drawing of Nun from a painting on the left panel of the Crucifixion Triptych, c. 1445. Kunsthistorisches Museum, Vienna showing the habit that was worn in medieval times. It had hardly changed in the days of Sherlock Holmes.
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I could not help but smile at his outburst and as I did so other "details" entered my head. "Holmes", I said in excitement. "Women in those days wore tight fitting clothing as they do now, that squeezed their breasts to their chest, in order to boost, dare I say, cleavage. Further many of the upper classes applied makeup to their bosom, faces and arms, a substance called ceruse or white Lead and used other preparations to enhance their beauty that was of dubious toxicity. In fact some of these women also got the nun's disease too while it remained exceeding rare among the lower classes. Holmes, I think we are onto something", I exclaimed.
Holmes smiled at me as one would of to a child who has discovered something new and exciting. "My dear Watson", he said. "Are you not forgetting something? Nuns wore habits, long flowing garments, and did not dub themselves with makeup. I fear that our line of enquiry is leading along a path that has no significance.
Now it was my turn to smile. "Holmes my dear friend". I said. "When it comes to women, your knowledge is truly lacking in this area, but as a doctor I am often in situations where my services require treatment of feminine ailments, and nuns are no exception."
Holmes looked at me in surprise and motioned me to carry on.
"Well", I said. "While it is true that nuns wear long flowing robes as you say, beneath them they wore a stay or similar garment that flattened their breasts close to their chests, and they wear it all the time. I can tell you it is quite a job to remove the garment when one wants to examine the chest area of a nun with a stethoscope." I explained that it was something to do with the church's understanding of chastity, and the need not to be a focal point of attention and a lure to men. However the exact details escapes me as it is an internal doctrinal matter of the church, and you know me and my thoughts about religion.," says I.
The face of Holmes lit up no sooner had my explanation passed his ears. For a moment he was silent, deep in thought then he said, "Ah! My dear Watson, there we come into those realms of conjecture, where the most logical mind may be at fault. Each may form his own hypothesis upon the present evidence, and yours is as likely to be correct as mine is. What else have you to tell me?"
For a moment I was lost for words, and my mind became filled with all kinds of loose facts trying to find one that would be relevant to the case. Then I remembered something that I had read in a history book. "Holmes my friend", I said. "It has occurred to me that those women of the upper classes of whom I have spoken and who contracted the disease did not breast feed their children. That was left to wet nurses. So this was something that both nuns and these women had in common.
"Thank you Watson", Holmes replied, "I was aware of this. Prey tell me what has breast feeding and a woman having her breasts squeezed to her chest by tight fitting clothing have do with this case?"
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| Dr Watson explaining about the Lymphatic System to Holmes.
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This question of my dear friend I could answer easily and I took delight in being able to express what I knew. I replied. "When the body has absorbed substances that are potentially hazardous, through the food we eat, the water we drink, what is floating around in our environment, like smoke and dirt, and what we touch through our skin, it has various mechanisms for getting rid of them. Besides the bowel and liver of which you are familiar, there is an intricate network of arteries where lymph, a clear fluid flows, known as the lymphatic system. This assemblage of arteries is connected to every organ of the body, but its function is completely different from that of the cardiovascular system. It is the garbage collector, the internal vacuum cleaner sucking up metabolic garbage, toxins and excess fluid from the extracellular fluid of every organ. If this flow is impaired, the fluid becomes thick and toxic". [1]
I was enjoying this lecture on a subject that I had been taught at medical school. Holmes was listening intently and so I continued with my narrative. "The lymphatic system is not connected up to the heart", I said. "So it has to rely upon some other activity to create the necessary pumping action it needs to circulate. The three most important methods of lymphatic circulation are external massage, muscle activity, and exercise. In other words it is movement that plays a key role in the lymphatic system's circulatory functions. Where women are concerned, a large mass of the lymphatic system is located in the chest and breast area, and these hazardous materials are expelled through sweat glands, especially those found under the arms.
"Of course my dear fellow", Holmes exclaimed. "In other words, if the lymphatic system is compressed by tight fitting garments, and breast movement is restricted in anyway as you have suggested, then the substances of which you speak will remain in the fluid and cannot be expelled. So what happens to the substances?"
I must confess that I was pleased at my own deductive powers and the praise of my friend was a wonderful accolade for a student such as myself in learning the ways of his deductionary methods. I recall that once Holmes had said to me that it was of the highest importance in the art of detection to be able to recognise, out of a number of facts, which are incidental and which vital. Otherwise, he said, our energy and attention will be dissipated instead of being concentrated. For the first time I began to understand the way he thought and as I contemplated the ramifications of what I had deduced I was astounded that nobody of my profession had not thought about what I had just described. I looked at Holmes and I could see a gleam in his eye that I had seen many times before when he was close to the solution of a case, or already knew the answer. But I was far to engrossed in my deliberations that I allowed myself to be swayed by the moment. Then I remembered something else that I had learned during my training as a doctor.
"Holmes you are correct in your analysis", I said. "The lymphatic system is filled with millions of one-way valves, which allows lymph fluid to flow unidirectional usually upward away from gravity. When a foreign substance is present, the body's first reflex is to expel or eliminate it. However if this elimination is suppressed by any means such as tight fitting clothing, some of this foreign matter gets suppressed (or pushed back into the system). Then, the very organisms or substances the body is intelligently attempting to eliminate become stored within the body and in any number of areas, usually in fatty tissues. As far as women are concerned, their breasts are an ideal temporary storage area for these substances because they are primarily made of fatty tissue, and so the substances gravitate into them and downwards towards the nipples. Normally, once the lymph flow begins again, the substances will be transported back into the lymphatic system and discarded through the sweat glands beneath the arms and elsewhere in the normal way. But if this process occurs and elimination is blocked, the body then becomes toxic just as you say Holmes. When the toxins cannot be removed due to congestion or blockages, the degenerative disease process begins. For women the substances gravitate downward in the breasts until as such time it settles into pockets of tissue where it remains. It is these substances, these chemicals that are known to cause cancer.
"How can you be sure that these substances, these chemicals are what causes cancer? he asked.
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| Chimney Sweeps got cancer of the scrotum because of the soot they inhaled when they were young.
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It was then I stole a look at the pipe that Holmes had laid on the side of the mantle piece, and he observed my momentary distraction. "Ah", he said. "You are referring to recent studies that show that smoking causes lung cancer, just as in 1775 the surgeon Percivall Pott described the occurrence of cancer of the scrotum in a number of his male patients, whose common history included employment as chimney sweeps when they were young. [2] Watson I take your point" As for breast feeding, the suckling action of the infant on the breast, the regular undulating motion being the mechanism by which the fluid is made to flow. I would imagine too that if the woman exercised this would also be effective, since movement is the key to lymph flow. Am I right Watson?
"Holmes you have been toying with me! You knew all along all the things that I have told you."
"Not so by dear Watson. 'Pon my word, it is a great thing for me to have someone to talk to, for my own thoughts are not over-orderly and there are gaps that you often fill that helps me to understand the full picture. Your knowledge of medical matters especially is, and has always been invaluable to me. Is there anything else you can tell me?"
It was now that I was able to reflect on what I had said and realised how little I had really offered. It was true that chemicals in smoke caused cancer, as it was equally true that toxic substances found there way into the body through various avenues such as eating contaminated food, or breathing chemicals from the air (or tobacco), or through the skin by touch. It was also logical that if the lymphatic system was restricted in anyway, such as the wearing of tight fitting clothes, especially in the case of women, the wearing of garments that squeezed and prevented the movement of breasts, then it would be reasonable to assume that cancer of the breast would be the result. Nuns and the upper classes both wore such garments and suffered the disease. Further both did not breast field any infants, and while some have suggested that hormones are involved, it is just as likely that the suckling child would in effect be massaging the breasts, and thereby stimulating the flow of lymph fluid in those areas. Then it dawned on me. "Holmes", I almost shouted. "Where did the nuns get the chemical substances that would have made them susceptible to the disease?"
"That my dear Watson is the crux of the matter on which everything hangs. Without that explanation, our efforts will have been in vain. It is obviously the same question that those of your profession will have asked but have failed to find the answer". With that he sat silent for a few minutes with his finger-tips still pressed together, his legs stretched out in front of him, and his gaze directed upward to the ceiling. Then he took down from the mantle piece the old and oily clay pipe, which was to him as a counsellor, and, having lit it once again, he leaned back in his chair, with the thick blue cloud-wreaths spinning up from him, and a look of infinite languor in his face. I imagined the chemicals that were pouring into his lungs, and the damage that it would be doing as he contemplated in silence the matter at hand.
I had had so many reasons to believe in my friend's subtle powers of reasoning and extraordinary energy in action that I felt that it would only be a matter of time before he would have some solid grounds for the assured and easy demeanour with which he treated the singular mystery which he had been called upon to fathom.
So we sat, in silence, lost in our thoughts. Then all of a sudden he exclaimed, "My dear fellow." says he, as we sat on either side of the fire in his lodgings at Baker Street, "life is infinitely stranger than anything which the mind of man could invent. We would not dare to conceive the things which are really mere commonplaces of existence. If we could fly out of that window hand in hand, hover over this great city, gently remove the roofs, and peep in at the queer things which are going on, the strange coincidences, the plannings, the cross-purposes, the wonderful chains of events, working through generation, and leading to the most outré results, it would make all fiction with its conventionalities and foreseen conclusions most stale and unprofitable. A big smile now crossed his face and he laughed.
"Holmes! What is it that you have discovered that sheds light on this most perplexing and singular of mysteries for I am completely at a loss as to find a it's solution?"
"Never mind," said Holmes, laughing; "it is my business to know such things. Perhaps I have trained myself to see what others overlook. The solution here is so simple that words almost fail me." He looked across to me, his face beaming with delight and mysterious countenance. "Tell me Watson, what did nuns do?"
Now I was completely lost! Everyone knew what nuns did. I collected together my thoughts and answered, "The life in the convent was almost identical those of the male gender who lived and worked in monstestories.
"Can you be more explicit my friend, and tell me what occupations the nuns were involved in?" .
"Well Holmes", I ventured to add. "Convents were basically self-sufficient in all they did. Besides spending time in prayer, the nuns worked in their garden growing vegetables, harvested what they grew, baked bread, did all the manual tasks associated in keeping the convent in good order." Much of what they did was very physical, and they all did this in the habit that they wore."
"True, Watson, but this was no more that what the peasants did in Medieval times, and they wore long flowing garments much the same as the nun's habit and correct me if I am wrong but there is little or no evidence that they suffered from the disease. Granted peasants breasts were not bound like those of nuns which may explain why they may have been protected from the disease due to the unrestricted movement of their breasts, and also that they suckled their young, but this explanation is inadequate in determining why nuns were more susceptible to the disease that other women".
"They made candles which the sold or bartered", I hastened to add.
Holmes smiled at this and he did not need to say anything, for I knew what he was thinking. Candle making was not confined to nuns but was a common trade, and as far as I knew, women of that trade did not suffer from breast cancer or any other cancer for that matter.
"Think Watson, think!"
For once I found myself unable to come up with anything more than that I had already said. "My dear friend, please put this bumbling fool out of his misery and tell me what it is that I have overlooked." says I.
With that Holmes said, "If you recall Watson, Bernardino Ramazzini of whom you mentioned was looking into the occupation of nuns when he found that breast cancer amongst them. These nuns were Catholic nuns. Does that signify anything to you my friend?"
Once again I found myself in a vacuum of knowledge on the subject, but just I was about to give up hope in offering a titbit of further relevance I remembered something that I had read long ago. There was one thing that Catholic nuns did that nuns of other denominations did not do. Surely, this could not be the reason I thought. It was too simple? In the Middle Ages and later, Catholic nuns were one of the few groups of artists who were able to illuminate thousands of manuscripts and weave intricate tapestries." [3]
"Ha!". You have stumbled upon the illusive clue that provides the solution to this case.
Pleased though I was with this my instinctive revelation, I remained none the wiser. "But Holmes", I remarked, " I still do not see the connection".
"Watson my friend, when you have eliminated all which is impossible, then whatever remains, however improbable, must be the truth. The world is full of obvious things which nobody by any chance ever observes. And like you, people see but do not observe. The distinction is clear. For example, you have frequently seen the steps which lead up from the hall to this room."
"Frequently." says I.
"How often?"
"Well, some hundreds of times." I replied.
"Then how many are there?"
"How many? I don't know." I said.
"Quite so! You have not observed. And yet you have seen. That is just my point. Now, I know that there are seventeen
steps, because I have both seen and observed.
By now I was becoming frustrated by my friend's ramblings. He knew the answer and I did not have a clue. I was desperate to know. "Holmes", says I. "Please do not keep me in suspense any longer but tell me the answer that alludes me." Then as an after-thought I quietly said a single word, "Norbury"!
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| Holmes discussing the final clue of the case
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For a moment Holmes was taken aback by what I had said. Then he clapped his thigh and laughed. He laughed so loud that Mrs Hudson came into the room to see what all the fuss was all about. I could not help but be amused at the sight of my friend convulsed as he was because of what I had said. To the reader who does not know the meaning of that word it has to do with a case my friend had undertaken. Norbury was the location of one of the rare cases when Holmes was not at his best; the case of "The Yellow Face" as it was called. He would sometimes say that he was ashamed of the affair. Even now", he would say. "I blanch whenever I go within even a few miles of Norbury." So it was that he said to me. "If it should ever strike you that I am getting a little over-confident in my powers, or giving less pains to a case than it deserves, kindly whisper 'Norbury' in my ear, and I shall be infinitely obliged to you." said he to me". Hence, he had asked me to use this word as a reminder to him to make sure that he did not become over-confident in the future, and on this particular occasion I was more than happy to oblige.
When Mrs Hudson had gone, Holmes settled down into his chair and quietly said, "Watson my friend, thank you for bringing me down to earth. You know that a conjurer gets no credit when once he has explained his trick; and if I show you too much of my method of working, you will come to the conclusion that I am really a very ordinary individual after all. But now I shall tell you what it is that you want to know.
HHe arose from his chair and went to the wall of shelves upon which his collection of books stood, in not so neat rows. As he took down a large volume near the end, he remarked, "The world is full of obvious things, which nobody by any chance ever observes." As he proceeded to open the great book on his desk I joined him, to see what it was that he was referring to. It was an Encyclopaedia,[4]and it was one that he often consulted judging by the tatty condition that it was in.
Holmes turned the pages and reached the heading of Illuminated Manuscripts and pointed to a diagram on the page. It showed a chart of the ingredients that were used to produce the paints in medieval times. Here Watson, within these pages we find the answer to that we have been searching. As you can see my good friend, many of the paint materials that were used in Medieval times and later thereafter, and therefore by definition used by nuns, were made from substances that are now known to be dangerous to health, as I am sure you will recognise my dear Watson."
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The Paint Materials used by those who illuminated manuscripts including nuns.
{Source: Wikopedia}
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Now I could see the connection and it was simple by all accounts. "Yes Holmes" I said. "It is obvious now that you have pointed this out to me."
"The world is full of obvious things which nobody by any chance ever observes" says he. "Now tell me what you know about these substances."
"Vermilion", I said. "Is a reddish orange pigment and has been used since antiquity. It was originally derived from the powdered mineral cinnabar but chemically the pigments is mercuric sulphide, and like all mercury compounds it is toxic. Orpiment is an orange to yellow mineral that is found all over the world. It was ground, processed and used for centuries as a pigment in painting, being one of the few clear, bright yellow pigments available to artists up until our century. It too is highly toxic, and if memory serves me right it has been used as a fly-poison and the Amazonian Indians used it to poison arrows.
"Well done Watson! Please continue. What else?"
"Verdigris occurs by the action of acetic acid when copper, brass or bronze are weathered and exposed to air or seawater over a period of time. The vivid green colour of verdigris makes it a very common pigment. Until this century, verdigris was the most vibrant green pigment available. It is poisonous, and has also been used as a fungicide. Lead is a poisonous metal, and anything made from it will be too. Hence, Lead white must be too. It is the oldest of the artist's white paint, believed to have been discovered by the Egyptians. Its strengths include its great opacity and its buttery, "ropy" consistency. Like the other paints already mentioned, it is very toxic. Lampblack or carbon black is better known as soot, a dark powdery deposit of unburned fuel residues, usually composed mainly of amorphous carbon, that accumulates in chimneys. Inhaling too much of this can lead to cancer the scrotum as Percivall Pott discovered. "Holmes, no doubt other paints and and pigments were used that are not listed in the book, and some of these would have been dangerous to health too."
"Watson, you are perfectly correct. Imagine a typical scene at a convent in the Middle Ages, or even in recent times for that matter. These materials you have described would have arrived in their raw state which meant that the nuns would have had to grind them into powdered form so that they could be mixed with a binding agent such as gum. This would not have been an easy task in itself. It is not unreasonable to assume that during the process of grinding the various substances, now ground to powder would be subject to being disturbed and distributed in the air as dust particles and breathed in as flour in a bakery. Further, the chemicals would have been absorbed through the skin of the hands and face as the nun prepared the pigments, completely unaware of the dangers they had been exposed to. The garments the nuns were wearing would also have become soiled and at the sometime, they would have been had washed. Needless to say the substances would have contaminated the washing water and those nuns doing laundry would have been exposed to the contaminants too.
Having prepared the paints, no doubt stored nearby and open to the air, those nuns who were especially selected for their artistic skills would have painstakingly worked on the manuscripts for much of the day, and would have been exposed to the chemicals for a long time. Slowly but surely, over a long period time, the poisons in the chemicals inhaled or absorbed would build up in the nuns bodies and because their breasts were bound as you rightly say Watson, the lymphatic system could not dispose of them. Nuns generally lived a long time and so it would have been inevitable that some of them would have suffered from the effects of this long term poisoning, and hence we can see the mechanism by which breast cancer developed. Monks at the monasteries who also carried out this type of work may have suffered other ailments, but as their chests were not so bound as those of nuns, their diseases would no doubt have differed. Now that would be an interesting area to research in, don't you agree Watson?"
Once again my esteemed colleague had solved a riddle that had taxed many a mind, including those of my own profession. Holmes had once said to me, "you know my method. It is founded upon the observation of trifles." and here I saw the truth of those words. And thus was solved the mystery of "The Case of the Nun's Disease". Alas, the aunt of Miss Miles passed away a week later at the age of 68, but not before she had been informed of the outcome of our deliberations. Upon hearing our conclusions, she was overjoyed. Now she knew why she had succumbed to the disease. She recounted that she had joined the convent when she was sixteen years of age, and much of her earlier years were spent in preparing the pigments for the illuminators. She herself was not an illuminator as she found the delicate work beyond her capabilities, but as for the preparation of the materials, that was a different matter. Although in recent years, the illumination of manuscripts had all but ceased in favour of the printed word, her exposure to the substances for so many years had clearly taken its toll. As for me I have written a paper for the prestigious medical journal the Lancet and am currently awaiting a reply.
Epilogue
Using the character of Sherlock Holmes and his methods for the basis of my analysis, I believe I am the first person to answer the riddle that has perplexed scholars and the medical profession for three hundred years or more - the riddle why nuns were more prone to breast cancer than other women. Nobody as far as I am aware has ever made the correlation between the materials used for the illumination of manuscripts by Catholic nuns, breast binding and breast cancer. Perhaps it takes a historian like myself with no axe to grind to sift through such "trifles" aforementioned by Sherlock Holmes and come up with a creditable solution to the mystery.
Sample Chapter from Breast Cancer "Cause - Prevention - Cure"
By Fred Harding
BREAST CANCER
