shrugged. “Not especially. A number of patients have their own rooms. Certainly, those with a tendency towards violence, like Norris, must remain segregated at all times, and chained. There are others, however, who, through good behaviour, have been granted the privilege of privacy. Matthews is one example. And there are those whose comfort is maintained by the generosity of their friends and family.”
“And the colonel?” Hawkwood prompted.
“Up until now, he was considered to be one of our most obedient patients.”
“You make him sound like some sort of lap dog.”
Locke smiled thinly. “Sickness is a strange beast, Officer Hawkwood, and none is stranger than sickness of the mind. There are those patients who thrive on the companionship of others and there are those who shrink from human contact. In either case, the patient’s welfare can also be affected by the circumstances of his or her confinement.” Locke raised an eyebrow. “You look at me as if I were mad. I assure you the theory is nothing new.
“Colonel Hyde is no drooling imbecile. He’s a well-born, educated man, a former army officer, and a surgeon to boot. He is not some prancing fool in a cap and bells. Indeed, I’d put it to you that, had you met and talked with him about the general turn of things, there’s every possibility you’d have considered him to be as sane as you or I.”
“Does he know he’s mad?”
Locke sat back in his chair. He was silent for several seconds before voicing his reply.
“You pose an interesting question. There are doctors who consider madness to be a sickness of the soul, a spiritual malaise. My own theory is that madness is in fact a physical disease, an organic disorder of the brain, which manifests itself in an incorrect association of familiar ideas, ideas that are always accompanied by implicit belief. In my view, the reason people see objects and hear sounds that aren’t there is not because their sight or hearing is deficient, it is because their brains are not functioning properly. Nor is their intelligence necessarily at fault. On the contrary, they will frequently reason correctly, albeit from a false premise. In their own minds they are being perfectly rational. And so it is with Colonel Hyde. He is perfectly lucid and articulate. He does not think of himself as either sane or insane. One could argue that is the nature of his delusion.”
“I’m sorry, Doctor,” Hawkwood said. “I still don’t understand. If you’re telling me that he was admitted into the hospital due to – what was it, melancholy? – what made him change? What made him commit murder?”
“To answer that, one would have to know how his delusion arose in the first place.”
“And do you?”
The apothecary shrugged. “In the colonel’s case, I’m not privy to the full facts of his admittance. It was Dr Monro who oversaw his arrival. I can only generalize.”
“Maybe it’s Monro I should be talking to,” Hawkwood said.
“That is certainly your privilege, though, judging by Dr Monro’s preoccupation with his extracurricular interests, I would submit that you would be unlikely to learn much. I doubt he has had one moment’s contact with Colonel Hyde since he was admitted. I can assure you, Officer Hawkwood, without fear of contradiction, that I am far more conversant with the colonel’s mental health than Dr Monro, who rarely attends the hospital, even for the Saturday meetings. But you must do as you see fit. There is also Dr Crowther, of course, though I doubt you’d find him sober, let alone lucid. When he is here, he does little except administer purgatives and emetics. That, Officer Hawkwood, is the sum total of their lamentable involvement. In their hands, treatment here amounts to little more than meaningless gestures. Purgatives are given to constipated patients. Syphilitics are prescribed mercury. Emetics are given to patients to make them vomit. It’s a way of ensuring that fluids move through the system. All other afflictions are prescribed laudanum. Do you know one of the side effects of laudanum? No? Well, there’s no reason why you should, but I’ll tell you anyway. It’s constipation. You see my point? Oh, and if the purgatives and the emetics don’t work, we bleed them or give them a cold bath. That way, they’ll either die from the flux or pneumonia. Purging, bleeding and inducing patients to vomit may be the recognized methods of mad doctoring, Officer Hawkwood, but they are not the way to treat patients like Matthews or Colonel Hyde.”
“You’re telling me there’s another way?”
“I believe so, yes. It involves a number of techniques, acquired after lengthy experience of dealing with such cases, but they all have one goal and that is for the doctor to gain ascendancy over the patient, similar to breaking in a horse or …” The apothecary paused expectantly.
“Training a dog,” Hawkwood said. He wondered if his moment of enlightenment would result in Locke rewarding him with a treat, a biscuit or a bone, perhaps? But it wasn’t to be. Locke continued, uninterrupted.
“Exactly. The patient must never think he or she is in control. It is not the patient who must set the agenda. It is the doctor. One must not confuse this with punishment, however. Corporal punishment, even severe chastisement, must always be considered a last resort. I do not believe it is possible to gain ascendancy over patients whose thoughts are constantly consumed by their plots to escape. I can safely say that by using understanding and kindness I’ve never yet failed to obtain the confidence and respect of insane persons.”
“Or their obedience?”
The apothecary inclined his head. If he resented the barb in Hawkwood’s question, he did not let it show. “Indeed. Honey, not vinegar, is the answer.”
“So that’s why he has his own room, his own belongings?”
“In part. And, as I mentioned, the colonel is not without benefactors. It is, however, more than anything, a matter of providing stimulation.”
“Stimulation?”
“You recall I mentioned the wound below your eye?” The apothecary pointed with his finger. “May I ask if you have suffered any other injuries; to a limb, an arm or a leg perhaps?”
Too many to remember, Hawkwood thought, though the most recent, the knife wound in his left shoulder, had been sustained not on the battlefield, but in the swirling darkness of the Thames riverbed. It wasn’t a memory he enjoyed revisiting.
He nodded warily and wondered where this was going. The apothecary was too damned perceptive, he thought.
“And during your recovery period, the more you used your arm, the quicker the wound healed; would I be right?”
Hawkwood nodded again. Though, if truth were told, the damned shoulder still ached with a vengeance if he slept awkwardly.
“And so it is with the brain. It is like a muscle. The greater the activity, the more exercise it receives, the healthier it is likely to remain. That is why the colonel was allowed his study area, his books and his drawings and his paper and pens. D’you see?”
Hawkwood nodded.
“They also proved most useful as a reward.”
“Reward?”
“For adhering to the hospital routine. It’s an established practice. We make the patient aware that if there are any infringements, privileges such as access to writing materials, personal possessions and so forth, may be withdrawn. For someone with the colonel’s intellect the removal of such privileges would be a very serious matter and, in the long term, likely to be detrimental to his health. A patient he may be, but with his military background he is a man who understands only too well the consequences of not observing protocol. It has proved a most effective system with a number of our patients.”
“Really?” Hawkwood said. “From where I’m standing I’d say the colonel didn’t give two figs for your so-called routine, or your damned protocol, and that makes me wonder just how well you knew him.”
“On an intellectual level, I would say I knew him tolerably well. I’ve spent a number of