Raven lifted the sodden dressing from the front of the abdomen. There was a small oval wound, the edges torn and blackened, a dark and malodorous fluid oozing out of it over his fingers. To his dismay he was jolted back to a different alley: the one in Berlin. That had been another moment in which he had instantly shed the person he was and become something else, but that night in Prussia the transformation had been driven by something less noble and more primal.

The image passed and he pulled himself back to the here and now.

He replaced the dressing and turned to face Flint and Gargantua.

‘This man was shot last night. One bullet. From a pistol. At close range.’

‘How can you know that from looking at a hole in his belly?’ Flint asked.

‘There are lacerations and bruising around the entrance wound. The edges are blackened as if they had been burnt. This arises from the heat and flame of the gunpowder at the moment of explosion.’

Flint and Gargantua seemed intent upon what he was saying, so he continued.

‘A bullet fired from a moderate distance produces a well-defined round or oval wound without blackening or burning. The feculent matters escaping from the wound indicate that the bowel has been perforated. There are signs of inflammation suggesting some time has elapsed since the injury occurred.’

Raven was relieved that he could recall these details from the Medical Jurisprudence lectures he had attended as a student. Flint looked impressed but that was unlikely to last.

‘What can be done?’

‘Given the fluid leaking from the wound, and the smell … there is no doubt that the intestine has been damaged.’ Raven lowered his voice. ‘Whenever the contents of the stomach or any of the bowels are effused over the surface of the peritoneum, death is the inevitable result.’

Flint and Gargantua looked at him in an uncomprehending silence. Raven sighed. He thought he had been perfectly clear.

‘There is no point in guddling about in this man’s guts. Surgeons only open the abdomen as a last resort, for the patient seldom survives it. In midwifery it is sometimes done to save the baby when there is no hope for the mother. Because once we have opened the belly, the mother will surely die.’

‘Why?’ Flint asked. There was no anger in his voice, only a bleak curiosity.

‘It would seem nature does not tolerate the exposure of organs it has seen fit to keep covered. Infection is the inevitable result. Much like gangrene in a leg, except in this case amputation of the infected part is not an option. However, the situation is immeasurably worse if the bowel itself has been injured. Hence there is no point in attempting to retrieve the bullet. The damage cannot be repaired. There is nothing that I or any surgeon, including Syme himself, can do in a case such as this.’