He looked around the room. There were no questions from the other three men, so the doctor rebuttoned his vest and sat down again. He crossed his little legs slowly, adjusting the trouser crease with care.
"Now," he went on, "the adrenals secrete several important hormones. The medulla secretes adrenaline, for instance. You have heard of adrenaline? The cortex secretes cortisol, which you probably know as cortisone. The adrenals also secrete sex hormones. Of sex, of course, you have probably also heard."
The doctor giggled.
"Get on with it," Sergeant Boone growled.
"Ah, yes. Sometimes the cortex, the covering of the adrenal glands, is damaged, or even destroyed. This can be the result of tuberculosis, a fungal infection, a tumor, and other causes. When the cortex of the adrenals is damaged or destroyed, it cannot produce cortisol. The results can be catastrophic. Weakness, weight loss, nausea and vomiting, low blood pressure, abdominal pains, and so forth. If untreated, the course of the disease is invariably fatal."
"And if it's treated?" Delaney asked.
"Ah, there is the problem. Because it is such a rare disorder, and because so few doctors are familiar with the symptoms, the disease is sometimes not diagnosed correctly. The early manifestations, such as weakness, nausea, constipation, and so forth, could simply indicate a viral infection or the flu. But as the disease progresses, one symptom appears that is almost a certain clue: portions of the body-the elbows, knees, knuckles, the lips and creases of the palms-become discolored. These can be tan, brown, or bronze patches, like suntan. Sometimes they are bluish-black, sometimes gray. The reason for this discoloration is very interesting."
He paused and looked about brightly. He had their attention; there was no doubt of that.
"There is a small gland in the brain called the pituitary, sometimes known as the 'master gland.' It produces secretions that affect almost all functions of the body. The pituitary and the adrenals have a kind of feedback relationship. The pituitary produces two hormones, ACTH and MSH, which stimulate the adrenal cortex to produce cortisol which, in turn, helps keep the ACTH and MSH at normal levels. But when the adrenal cortex is damaged or destroyed, the levels of ACTH and MSH build up in the blood. That is what has happened to our killer. Now, MSH is a melanocyte-stimulating hormone. That is, it controls the melanin in the skin. Melanin is the dark brown or black pigmentation. So when there is an abnormally high level of MSH, there is an accumulation of melanin, which causes discoloration of the skin and is an indication to diagnosticians that the patient is suffering from adrenal cortical insufficiency, or Addison's disease."
Dr. Patrick Ho ended on a triumphant note, as if he had just proved out a particularly difficult mathematical theorem. QED.
"All right," Delaney said, "I've followed you so far. I think. And the high potassium level and the other stuff?"
"Also classic indications of Addison's disease. Especially the low sodium level."
"Tell me, doctor," Thorsen said, "if someone has Addison's disease, can you tell by looking at them? Those skin discolorations, for instance?"
"Ah, no," Dr. Ho said. "No, no, no. With proper medication and diet, an Addisonian victim would look as normal as any of us. They are somewhat like diabetics in that they must take synthetic cortisol for the remainder of their lives and watch their salt intake carefully. But otherwise they can live active lives, exercise, work, have sex, raise families, and so forth. There is no evidence that Addison's disease, adequately treated, shortens life expectancy."
"Wait a minute," Delaney said, frowning. "Something here doesn't jibe. Assuming our killer has Addison's disease and is being treated for it, her blood wouldn't show all those characteristics, would it?"
"Ah-ha!" Dr. Ho cried, slapping his palms together gleefully. "You are absolutely correct. One possibility is that the killer is in the primary stages of Addison's and has not yet sought treatment. Another possibility is that she has sought treatment, but her disease has not been correctly diagnosed. Another possibility is that her disorder has been properly diagnosed and prescribed for, but she is not taking the proper medication, for whatever reason."
"That's a helluva lot of possibilities," Boone grumbled.
"Ah, yes," the doctor said, not at all daunted. "But there is yet another possibility. Addisonian crisis may be brought on by acute stress such as vomiting, an injury, an infection, a surgical procedure, even a tooth extraction. And, I venture to say, by a prolonged period of severe mental, emotional, or psychic stress."
They stared at him, slowly grasping what he was telling them.
"What you're saying," Delaney said, "is that you believe the Hotel Ripper is suffering from Addison's disease. That she is being treated for it. But the treatment isn't having the effect it should have because of the stress of ripping open the throats of six strangers in hotel rooms. Is that it?"
"Ah, yes," Dr. Ho said placidly. "I believe that is a definite possibility."
"That's crazy!" Sergeant Boone burst out.
"Is it?" the doctor said. "What's so crazy? Surely you will not deny the influence of mental and emotional attitudes on physical health? The close relationship has been firmly established. You can will yourself to live and will yourself to die. All I am saying is that the physical health of this woman could be adversely affected by the strains and fear connected with her horrible activities. There may be a psychological factor at work here as well. If she acknowledges the evil of what she is doing, sees herself as a worthless individual not fit for society, that too might affect her health."
"Look," Deputy Thorsen said, "let's not go off into left field trying to figure out the emotional and psychological quirks of this woman. We'll leave that to the psychiatrists after we've caught her. But let's just stick to what we've got. You think she's suffering from Addison's disease, and either it's not being adequately treated or she's ignoring the treatment, and the stress of these murders is killing her. That sounds silly, but it's what you're saying, isn't it?"
"Approximately," Dr. Ho said in a low voice.
"So?" the Admiral said. "Where do we go from here? How do we begin finding everyone in New York City suffering from Addison's disease?"
They stared at each other a moment.
"Go to all the doctors?" Sergeant Boone questioned. "Ask them if they're treating anyone with the disease?"
Edward X. Delaney wagged his big head, side to side.
"Won't work, sergeant," he said. "You know the laws of confidentiality regarding privileged information between doctor and patient. The doctors will tell us to go screw and the courts will back them up."
"Edward," Thorsen said, "suppose we go to all the doctors in the city and instead of demanding the names of any patients they're treating for Addison's disease, we just ask a general question, like, 'Are you treating anyone for Addison's'?"
Delaney thought a moment before he answered:
"If a physician wants to cooperate with the cops, I think he could answer a general question like that without violating the law or his code of ethics. But what the hell good would it do? If a doctor answered, 'Yes,' then our next question would have to be, 'What is the patient's name and address?' Then he'd tell us to get lost and we'd be right back where we started."
They sat in silence, staring at their hands, the walls, the ceiling, trying to come up with something.
"Dr. Ho," the Chief said, "in answer to one of the Deputy's questions, you said an Addisonian victim would not have those skin discolorations if she was receiving the proper treatment. Right?"