Highbrow Horror : DR. HAGGARD’S DISEASE, <i> By Patrick McGrath (Poseidon Press: $20; 182 pp.)</i>

This wonderful and ghastly novel of sexual fixation comes from an author who, with his first two novels, became known for his facility in avant-garde gothic, also called neo-gothic or post-modern gothic. In “Dr. Haggard’s Disease,” Patrick McGrath sends us once more into a world as grisly and swollen with malignant intent as the background of a Francis Bacon painting.

During the second World War, Dr. Edward Haggard, a practitioner in an English seaside village, is visited by a young pilot who turns out to be the son of Dr. Haggard’s illicit ex-lover. The pilot’s questions lead the doctor into a painful recollection of his old love affair in London during his medical training, before the war.

But this is no simple retelling of events; Dr. Haggard takes us into both his past and his future, not just divulging the story of his lost lover Fanny, the wife of the morose pathologist Ratcliff, but at the same time moving ahead in time to examine his flourishing fixation on her son. In a stylized manner reminiscent of du Maurier, Durell and Poe, McGrath skillfully foreshadows catastrophe, making the reader certain that past disasters will herald future ones.

Dr. Haggard’s passion for the pathologist’s wife is not his only disease. His morphine addiction is another. And there is a peculiar disorder of the “glands” he sees progressing in James, his ex-lover’s son, a unique disease the doctor feels he has discovered himself and could even give his own name to; yet by the time this disorder is fully described, we begin to wonder not only if Dr. Haggard imagines all the strange hermaphroditic symptoms he sees in the young man, but if those symptoms are actually his own and not the young man’s at all.

Dr. Haggard has a further affliction: “Spike,” as he affectionately dubs an intensely painful and permanent hip injury, a fracture with a pin riveting the bones. Early in the book Spike could easily pass as a war wound, with all accompanying honors. McGrath makes constant and adept use of Spike as a reflection of the doctor’s emotional and physical pain. At one point Dr. Haggard, brooding on a possible ghostly visitation from his lost love, envisions that “Spike . . . held the slim phantom close, held her clinging to the pin in my hip like a plasmid substance, translucent, faintly shining. . . .”

But once the reader suspects Spike to be an injury of disgrace, not heroism, the doctor’s reliability as a narrator begins a slow, downward slide. This decline is strengthened by glimpses of medical incompetence. A bungled appendectomy, in which he sews his own rubber glove into the wound, nearly leads to his dismissal from the hospital. He shrugs off his misdiagnosis of a patient’s fatal kidney dysfunction, dismissing her as a neurotic and neglected housewife. “Not enough sex,” is how he classifies her. When he later ponders his mistake, his regret is over in a word or two. To add a dimension to his questionable expertise, he casts doubt on colleagues’ medical treatment of his ex-lover, when a disease of her own comes to light.

McGrath’s use of the second person, with the “you” Dr. Haggard addresses being the young pilot, would at first seem to limit narrative possibilities. But as the pilot’s fate is repeatedly mentioned, the voice grows elegiac, and pulls in not just events the doctor knew but ones he imagined as well. A certainty grows that Dr. Haggard is not completely rational, and has been pushed over the edge of ordinary life into what he calls his “grief-torqued imagination,” illustrated so well by his nightmare of a German bomb annihilating the rear of his house while the front remains whole, a facade of normalcy.

“Dr. Haggard’s Disease” abounds with creepy, kinky details which, if they had been turned up a degree or two higher in camp intensity, could have been hilarious, as they are in “Grotesque,” McGrath’s first novel. In this new book they subtly work to create a world of dark apprehension.

Among these wonderful, macabre details are recurring motifs, like somber versions of Chagall’s angels, from McGrath’s two previous novels, which show up again in “Dr. Haggard’s Disease”: draping a man in a woman’s decaying fur coat successfully depicts his descent into moral or mental decay. Men kiss, passionately. Not surprisingly, McGrath’s characters are often outdoors in violent rainstorms and other bad weather.

As in his other novels, McGrath shifts points of view by allowing his narrator to imagine the thought and actions of other characters, and he does it so smoothly that it’s hard to mind this one weakness in his storytelling.

Especially entertaining is McGrath’s somewhat British inclination to give proper names the evocative weight one sees in Dickens or Trollope; some as obvious as Haggard, Ratcliff, Fanny; and other less so, as in the housekeeper Mrs. Gregor (so like Igor, the quintessential hunchbacked attendant in any gothic mansion) and Elgin, the doctor’s dreary cliff house, which recalls not just elegy but also Elgar and his funereal music. Jubilee Road is the ironic location for Dr. Haggard’s bleak London flat (where you will find the human skull ashtray).

By the time Dr. Haggard recounts Fanny’s final choice of whether or not she should stay with her pathologist husband who smells of formaldehyde and is sexually inert (or so Dr. Haggard is led to believe), she has been cast in a new light. One questions all the passion she showed to Dr. Haggard and the moral perfection he attaches to her. Distasteful details about her come back to the reader; her casual defense of Hitler (before the war has started), her odd gift to Dr. Haggard of a housefly preserved in glass, and her indifference to her son’s dangerous choice to become a fighter pilot.

But by the time Dr. Haggard reaches this point in his tale of his past, the present sees him morbidly infatuated with the pilot, his love stemming not only from the young man’s resemblance to his mother but from the doctor’s growing conviction that the spirit of the mother has somehow entered he son.

When Dr. Haggard’s lonely adoration leads to a final, horrible tableaux grimmer than any previous scene, there’s an impulse in the reader to go back to the first page and start over again, to try and unravel the doctor’s terrible downfall, and to see how Patrick McGrath created such a perfect little book.