Ankylosing spondylitis in the wrists, forearms, and spinal column
Note the fused wrist bones in the arms, and the abnormal protuberances, fusions, and cavities in the spine.
Ankylosing spondylitis (also known as Bechterew’s disease) is an inflammatory spondyloarthropathy (arthritis affecting the spinal column), and its name comes from the Greek “ankylos-”, meaning “crooked”. Spondylitis can be broken down into “spondyl-” and “-itis”, which mean “spine” and “inflammation”, respectively.
Simply put, it’s a fusion of the joints in the axial skeleton (the spinal column, ribcage, and cervical collar), but there’s little else that’s simple about this condition. While it’s known to have a strong genetic predisposition and heritability, the exact triggers that begin the process of syndesmophytosis (literally "the process of abnormal binding together") which fuse bones together is not known.
While many of the genetic and immune factors in AS similar to those in rheumatoid arthritis, ankylosing spondylopathy has been differentiated from other RA conditions as early as the second century CE, by Galen. Because of its effect on the spinal column, AS has long been known as "bamboo spine".
Unfortunately, despite many treatments and therapies being available to counteract the effects of this autoimmune condition on the bones and organs, there is no cure.
Observations on the hip joint: to which are added … other similar complaints. Edward Ford, 1810.
Pink lady, pink case, pink phone – there was a lot of pink. Did you like it?
This is a CAKE! Severed hand CAKE!
It appears to be water damage. Or perhaps freezing. A decent study in anatomy.
Count Me Among Thy Saints
Mycroft woke fourteen minutes before his alarm was set to sound. He was tempted to close his eyes for another few minutes, but a lifetime of early mornings had taught him that it just wasn’t worth it. He manually switched off the alarm and rubbed his hands over his face, working the sleep from his features.
Alright, fifteen minutes to clear out, then on to the train station. What I wouldn’t give to have Anthea organizing all of this…
He glanced around the room, surprised to find that Sherlock was no longer with him. He expected his brother to still be reviewing files or perhaps to have nodded off in a corner. Realizing that it’d take time to round Sherlock up, he forced himself to stand, and began the search for his sibling.
The kitchen was the first place Mycroft checked, assuming that his brother had sought caffeine or sustenance during their lapse in activity. He hadn’t planned on finding Sherlock slumped against the wall, back hunched, despondent. He would have assumed that Sherlock was asleep, had he not encountered this scene before. The sweat drenched locks, the gentle tremors in his hands, the the ultra-slow rise and fall of his chest; they told a different story.
Leave him. Just leave him.
The dull ache behind Mycroft’s eyes caused by insufficient sleep had ignited, and was matched by the burn of anger in his chest. In that moment the elder sibling was overcome with a feeling of deeper hatred, vehemence, and frustration than he could ever remember experiencing. Whether it was directed at the man, the substance, or the habit, he couldn’t say. Only years of controlling his temper kept him from resigning from his fraternal obligation; leaving his strung out brother to melt into the floorboards while he returned to the comforts of home.
Instead, he examined the scene, finding both of the scribbled notes his brother had left, as well as the remnants of his indulgence. Cocaine and Heroin.
“Bloody hell and all the sinning saints,” Mycroft breathed finally, pinching the bridge of his nose. He needed to get them both out of the house, discreetly, before sunrise. Sherlock was catatonic, and based on what he’d taken, would be out of commission at least until they had boarded the train.
Mycroft crumpled up the papers. He’d already logged away the information they contained, and their existence only made him angrier. Sherlock’s binge had been premeditated enough that he’d bothered to leave dosage records, and that, in some ways, was less forgivable than an impulsive choice to use.
Why didn’t you come get me?
As his anger shifted to guilt, he was overwhelmed by the desire to dig his foot into his brother’s ribs.
Instead, he dampened a kitchen rag, knelt down, and wiped it over the other man’s face, dragging it backwards over Sherlock’s scalp so that it slicked back his hair.
He said nothing. Any words would have been wasted.
The pounding noise needed to stop. Now. The pounding needed to— Sherlock lurched into consciousness and across the cramped cabin into the equally cramped bathroom nearly within the same breath. Heaving, his throat spasmed open and closed as his stomach desperately tried to empty itself as quickly as possible. A burning sensation spread from his gut upwards making him heave even more though there was nothing left. Long minutes later, after he’d calmed, he flushed and rested his head against the bowl, fighting the dizziness that now threatened to overwhelm him.
Mycroft folded his newspaper, but stayed in his seat. He’d managed to get them to the train on time; as far as he was concerned, his duties in this drug addled debacle had been fulfilled and Sherlock was on his own. His brother had sobered up and since dying from overdose was no longer an issue, the only thing left to do was stare condescendingly at the bathroom door, so that upon exiting Sherlock would be greeted by his hawkish gaze.
Which was exactly what Sherlock saw as he emerged, still shaking, from the bathroom. Without saying a word or acknowledging Mycroft’s presence he drank gratefully, although in small sips, from the bottle of water on his bench.
“Blood on your hands and drugs in your system. John would be so disappointed,” Mycroft said eventually. He didn’t bother sharing his own feelings on the issue; they wouldn’t have mattered to Sherlock.
The mere mention of John produced a visceral reaction from Sherlock who reared back before groaning in pain. He also looked down, intrigued, at his hands. No blood. Mycroft must have washed him up then. “Thank you,” he croaked still unable to say anything else without feeling ill. He lapsed back into silence to focus on using his considerable brain power to stop his body from shaking, his stomach from trying to escape through his mouth, and the world from spinning around so quickly.
Mycroft didn’t bother answering, but he continued to stare at the shuddering form of his brother. He had plenty to say, but he knew a few sharp tongued quips wouldn’t be worth the fight that would follow. If Sherlock hadn’t learned by now, he never would. Instead he watched his sibling, a vision of silent judgement.
After thirty or forty minutes and most of the bottle of water Sherlock finally felt up to attempting to explain himself. A sign of John’s influence, not that he’d acknowledge such a change, and in deference to trying to salvage the rest of this trip with his brother Sherlock felt it necessary to tell his brother why he’d turned to drugs. He sighed so as to break the heavy silence before opening his mouth. “I couldn’t stop replaying it. The blood, I’m used to the blood, but-” he paused, “I wish I had done it during the fight. I wish I hadn’t waited. I couldn’t stop seeing the image of her closed eyes, like she was sleeping. I wish she had struggled.”
He paused and took a large swallow of water, sputtering a bit before he sobered and finished what he had to say, “I just needed not to see for a bit.”
Inflating a set of cat lungs
Lungs are by most accounts mundane. Everybody has them, few give it much thought. But sequestered within darkness of the chest cavity, enveloping the fluttering heart, there’s a incredible wonder to this oddly inflatable organ.
Dissection is a destructive process. Rudely excised from membranous mooring and nourishing vessels, the deflated lungs appear little more than bloodied meat; amorphous and exposed…….until a breath of air unfurls its secret glory.
Here, a set of cat lungs is inflated with a straw. Comprised of hundreds of millions of microscopic air sacks called aveoli, Mammalian lungs harbor air capacity that is difficult to believe unless seen. The color of the entire organ lightens into a soft pink, as each microscopic sac fills with air.
A debt of gratitude is owed to cyborgraptor for her assistance in creating these gifs, as well as the students that help me film this demo.
Count Me Among Thy Saints
“A headache. Financial records. Address book,” Mycroft replied, before tossing the map he’d been writing on to his brother. “Take a look at that, I have every street and location she mentions recorded in a notebook for future reference. Munich is centrally located, it’s more than likely a hotbed of criminal activity throughout Europe. There are two names in her address book that I recognize; one is a wanted gun-for-hire, and the other is a smuggler from Monaco that has already done jail time. I’m trying to check records on the others, but accessing the database without giving away our location is holding me up. I may have to wait until we’re in a more secure location.”
“Not a bad start,” Sherlock remarked casually as he added to Mycroft’s map. Turning to look around at his brother he asked, “What’s next?”
“We need to leave here by sunup, and I want to be out of the country by noon. I’ve already booked train tickets for Germany,” Mycroft answered. “I want to see what other information we can find about Russia, Munich is the place to start. Sleep if you can, I’ll set an alarm for four.”
The bureaucrat stood, stretching the ache from his back. He was sore, and desperately needed a shower. He wanted to shave, the whiskers on his cheeks were beginning to itch, but he’d consented to growing them out while abroad. It’d help keep him unrecognizable, as long as he could bear the discomfort.
He looked to his brother for a few moments, before shrugging off his jacket.
“I’m going to clean up the hallway a bit.”
“Don’t bother, I staged the scene already. Try not to tread over there until we leave. Use the back stairs if you need to go down to the kitchen.”
“Don’t shave either. Find some lotion in the bathroom and rub it in, it’ll help with the discomfort.”
“Fine. We’ll reconvene in a few hours,” he offered, before leaving his brother alone.
Spending a few more minutes in the bedroom finishing his additions to the map Sherlock wandered out to the landing and glanced around, briefly considering the suggested nap before deciding against it and heading downstairs to scope the kitchen. In their haste to find the documents while Baillet was alive and unconscious the brothers had neglected to thoroughly search most of the house. And while Mycroft’s body had no experience dealing with the crashes that came with large bursts of adrenaline, Sherlock, the addict, did. He’d sleep again on their way to Munich.
Beginning in the kitchen Sherlock raided the refrigerator for snacks before moving on to the cupboards. Systematically he moved through the kitchen looking without believing he’d find anything they may have missed. So it shocked him, when feeling at the back of Baillet’s ‘junk drawer,’ to find a clear plastic bag.
Which was how, Sherlock Holmes found himself sitting alone at a table, in the middle of the night, in the silence of a dead woman’s home staring at a bag of drugs. Not just a bag either, a quart sized sampler pack of every drug he’d ever taken plus a few he imagined that were still in their developmental stages.
Until he’d found the drugs Sherlock had managed to push away thoughts of pulling the trigger so he could work. But now— he looked down at the bag in his hands and noticed that he’d never actually washed himself after blood from him nose had mixed with the blood from Baillet’s head. Rust red flakes clung to his hands and streaked up his forearms. If he had a mirror he imagined he’d see the same across his face as well.
He should shower. He should leave the room. He should give the drugs to Mycroft to dispose of. Whatever happened next, Sherlock Holmes should not continue to sit alone at a table, in the middle of the night, in the silence of a dead woman’s home staring at a bag of drugs.
But when had he ever gone to Mycroft on a danger night?
Opening the bag with steady hands he calmly laid out its contents on the kitchen table, sorting the drugs into those he recognized, those he could deduce their contents, and the unknown. Keeping enough presence of mind to discard the unknown pile before he started, Sherlock then reached out to take the bag of cocaine, efficiently laying out five lines before snorting them. As he waited for it to take effect he grabbed up a pen and paper from the counter and wrote out “Cocaine, high grade?, 0.5 grams” before resting the paper on the table on top of the leftover powder.
Fifteen minutes later Sherlock furiously paced the around the kitchen table, no calmer than before. Designer drugs straight from the designer and I’m not high. Unacceptable. Unacceptable. Unacceptable. Unacceptable. Unacceptable. Unacceptable. What else can I do? What else can I take? Must- must- must- fix this. Must stop this. Must stop.
Striding over to the table once again Sherlock looked over his options again. Heroin this time then. He’d avoided it in the past since a bad heroin high would disable the detective for days but the cube of black tar in his hand was clearly pure . He’d need only about 10 or 15 milligrams to get the job done. Mixing hot water into the slice the consulting detective wrote out what he’d taken before snorting, “Heroin, black tar, pure, 0.10mg.”
The burning pain in his nostril had barely faded before he could feel the high beginning to take effect. Not content and still fixated on the image of Hortense Baillet’s closed and unconscious eyes as he placed a gun between them, he scrambled up to the table again, when had he gotten on the floor?, and scratched out the 0.10mg replacing it with “0.15mg” and repeated the process.
Count Me Among Thy Saints
Mycroft turned away from the door locks to find his brother covered in what he assumed was his own blood, and the french woman incapacitated on the floor. Immediately his eyes moved to the corners of the corridor, and he hissed with displeasure.
“I knew this would be an issue,” he grunted, raising his beretta. He quickly snapped off two rounds, destroying Baillet’s security cameras in a spray of static and shattered parts. He then moved forward purposefully, seeking out the keypad that would deactivate the security system.
While Mycroft took care of the security system Sherlock began rifling through the rooms of the small flat looking for Baillet’s computer, filing system, and safe. Depressingly he found it under her bed, how predictable.
“It seems our friendly neighborhood gun-runner has a bit of a trust issue,” he called out to Mycroft as he spread his find across the floor of her bedroom. “We may not need to speak with her after all.”
Mycroft was busy with the keypad. He held a pocket sized torch between his teeth, leaving his hands free and the box illuminated. He’d managed to pry it from the walls, but disconnecting the board from the wires would potentially trigger another silent alarm that would alert the security provider. Knowing that he was wasting valuable time and that Sherlock was already tearing through the apartment tripping lord only knew what, Mycroft ripped one of the wires free, and left the others connected. He paused for just a moment before ripping out the second, which he knew would disable the cameras and motion sensors. He waited a moment longer before removing the torch from his mouth.
“I think the security is down,” he called, just as a tinkling of music chimed through the hall. Instantly Mycroft felt his stomach flip, and he turned back to face Hortense.
“And that would be the provider calling to report that the system is offline and to ask whether there’s an emergency,” the elder Holmes sighed, quickly patting down the woman’s body in an attempt to find her phone. “Sherlock, we may have to wrap this up quickly if I can’t convince these bastards that I’m Miss Baillet!”
Rolling his eyes Sherlock swiftly picked up the phone. In a husky, roughened voice he barked in fluent French, “Quoi? Que pourriez-vous avoir envie en ce moment?” Pausing for only a moment he moaned a bit and turning his mouth away from the receiver breathed, “Oui, oui, attends mon amour, attends-moi pour obtenir cet idiot éteindre le téléphone.”
Mycroft kept quiet, knowing that hearing two male voices on the phone would be suspicious in an already suspicious situation, and elected to swap roles with Sherlock. With a look that clearly said, “don’t get cocky”, Mycroft turned on his heel and ventured into the flat.
Not five minutes later a single shot echoed and Sherlock re-entered the room again wiping blood off of his face and hands. Not at all perturbed by what he’d just done he sat down on the ground and resumed sorting through the paper files spread on the floor, leaving the computer in his brother’s care.
Mycroft knew immediately what had happened when he heard the gunshot. There’d been no sound of a struggle, and Sherlock was aware of his surroundings. Hortense Baillet was dead, and he was an accessory to murder. He ran through the list of things he wanted to say to his brother in that moment, but when Sherlock walked into the room, painted in blood spatter, his words failed him. There was a long, pregnant pause where Mycroft stared at his brother, wondering if he was averting his gaze on purpose. Finally, the elder Holmes looked back at the computer in his lap and murmured,
“I’m amazed they fell for your performance; she’s clearly a lesbian.”
“Again Mycroft,” Sherlock returned unconcerned, “You’re forgetting how stupid most people are.”
“Yes…It seems I am consistently underestimating what people are capable of.”
“Hm,” Sherlock responded not connecting the comment back to himself.
The brothers worked in tandem well into the night going through Hortense Baillet’s papers and files to comb for the relevant information they needed to track down the web. It seemed that her propensity for saving tidbits and old plans, whether out of compulsion or safety it wasn’t clear, worked out in their favor.
Mycroft had begun to assemble a pile of papers and documents that he planned on bringing with them. He’d also pulled out a map of Europe, and was marking each reference point and place name he’d found relevant. A bevy of red marks were collected around several cities, the most prolific was Munich. He added another mark to the map and recorded a street name in a notebook, simultaneously fighting the heavy droop of his eyelids. Adrenaline expended, he was beginning to fade.
“Do you have anything to share?” Mycroft asked, checking the computer screen. The files were two thirds of the way downloaded to an external flash drive, but it still had about an hour to go.
Flicking through sheaths of paper Sherlock groaned a bit as he once again became aware of his surroundings, “Oh yeah,” he remarked with sarcasm, “loads. She was having an affair with the waitress at the cafe down the road, and another with the wife of a contact up in the Normandy region, as well as a third with a woman she met online.”
Shaking his head a bit and standing to walk circuits he continued on a more serious vein. “Africa, Asia, the Americas, and the Middle East are lost. Moriarty had only begun staking serious claims there when he appears to have either gotten bored with the game or distracted by me. Since his death they’ve fallen back into the old status-quo. Ergo, not our problem.” He looked to Mycroft for confirmation.
“What a naive little world view you have, must be so nice,” Mycroft countered. “What are your opinions on Munich, if any?”
“Fine then, not my problem,” he corrected, stressing the personal pronoun. “Munich,” he flicked through a separate, and far larger stack of papers, “Munich, Germany, Munich. Yes Ms. Baillet did a quite a bit of business with Munich, she never stated outright in what I’ve got but I’d guess drugs. It seems the most logical conclusion in conjecture with the guns she was responsible for. I’ve also got plenty of vague references to work deeper in Eastern Europe and something else large and important in Russia. It all dovetails nicely to what we know of the remnants of the London base and Moran.”
“What do you have?” Sherlock yawned.
Photo by halflink.
It’s a fake!
Sherlock’s out of character “Laterz” at Buckingham Palace is not only a passive-aggressive sign of contempt (and parting shot at Mycroft, who almost got him to behave himself)- it may also refer to Sherlock’s secret guilty pleasure of watching what John freely admits in The Great Game to be “crap telly.”
Benedict Cumberbatch as Sherlock by Ian Derry for Entertainment Weekly