Human Traces

  The lunatics began to walk down the avenue, their heads low, some supported or cajoled by family, some resolutely alone. Many were in the clothes of the workhouse, some brightened with colourful additions, gifts or remembrances of home. For most of them, the journey was almost over: another hundred yards of park and drizzle, then the doors would swing shut behind them. In the terraces or slums, the farm cottages, shops or houses that had once been home, this evening would begin with candles, lamps or gaslight; there might be Bible reading and sewing; there might be strong drink and violence; but from all this and much more that passed for normal they were now removed. In a place of safety, in the name of comfort, they were hereafter free to relinquish their struggles with the life outside and battle only with their several realities.

  Attendants brought the women one by one to Thomas when he took his seat behind the trestle. He was handed two doctors’ reports for each patient. Some were cautious and detailed: ‘Patient imagines herself to have been hypnotised. She declares she hears voices, and instances one as saying that her brother has been shot. They order her to carry out various acts. She declares there is electricity in the air that acts in her. Her appetite is poor and she has become anaemic.’ He looked up and saw a woman in a black dress, half bald, with strong features, and hands like a man’s.

  ‘Do you know where you are?’ he asked. ‘What is your name?’

  She had been transferred from a private asylum where she lay with sheets over her head, talking to voices in a state of agitated depression.

  ‘How do you feel? We are going to make you better.’

  ‘Classification,’ muttered the female attendant on his right.

  Thomas sighed. ‘Dementia.’

  ‘Refractory?’

  ‘I cannot say after one minute with the patient.’

  ‘Looks like it. Look at the hair. Put her in Twelve B.’

  ‘B?’

  ‘Basement. Refractories. If it turns out she’s not, so much the better. They need some quiet ones even if it’s just to help muck out the room.’

  ‘All right. What is your name?’

  ‘Miss Whitman. Senior attendant, ladies.’ She spoke with a genteel, enunciated precision.

  ‘Dr Midwinter.’

  ‘I know. You have another customer.’

  ‘When can I see the first lady again?’

  ‘Whenever you want, young man. There’s no appointments books here!’ Miss Whitman let out a deep laugh. ‘Come along now.’

  Some doctors’reports were more outspoken: ‘Acute maniacal excitement. Says she is pursued by animals and passes her nights in what she calls “a sweat of death”. Uses foul language and displays her private parts. Clothes dishevelled. Appearance that of a lunatic.’

  ‘How old are you?’ said Thomas. ‘Do you have children?’

  ‘They murdered my baby in the hospital. Stuck a needle through his throat till he choked on blood.’

  ‘Have you been in a hospital before?’

  ‘Of course! That’s what done for me.’

  Thomas was aware of McLeish barking out a single word every thirty seconds to his left as the queue of men diminished in front of his table: ‘Melancholia. Ward Fifteen. Epilepsy. Nine.’ His dog was snoring loudly.

  Thomas turned to his attendant. ‘Do we have a ward for puerperal mania?’

  ‘We don’t say “mania” in front of them, it gives them ideas,’ said Miss Whitman. ‘Just a number. Put her in Five.’

  ‘Not Basement?’

  ‘Wait and see.’

  ‘Before you go.’ He looked down at the papers and saw her name. ‘Mildred. Do you have a husband, Mildred? A family? When you feel better you can go and see them. Did you know that?’

  The woman laughed as she was led away into the corridor. Thomas watched her recede, slowly, into the narrowing, darkening distance.

  Another patient was waiting. Thomas found that each time he looked up from the doctors’ reports to the woman herself, he hoped to meet the eye of understanding, to look into the face of someone whose awareness of the gloomy hall in which she stood was something like his own. Each time he was disappointed, and the notes he read, while full of individual incident, delusion of almost comic peculiarity, began to take on a strangely familiar air. ‘Convinced that a murderer is after her . . . incoherence of manner . . . thinks she is pregnant (which she is not) . . . careless and filthy about her person . . . injured herself with a breadknife . . . profound melancholia . . . believes God is coming for her . . . crimes she has not committed.’

  ‘Classification!’

  ‘Ward Eight,’ said Thomas quietly. ‘. . . Unless we have a ward number for Unknown.’

  Alerted by some peculiarity, he stood up to examine the next patient, a girl of about twenty with a red bow in her hair, clear skin, full skirt and beige bodice, sweat-stained beneath the armpits.

  ‘Where are the notes for this patient?’

  ‘There are no notes. She’s workhouse. No family.’

  Thomas laid his hand on the young woman’s arm. ‘What is your name?’

  She pulled her arm back, but did not speak.

  ‘How old are you? May I touch your face? I promise I won’t hurt. There. I didn’t hurt you, did I?’

  She shook her head.

  ‘We must give you a name,’ said Thomas, ‘otherwise you will have no record and I fear you will disappear for ever down that corridor. What name would you like?’

  The woman said nothing, and Thomas peered closely into her fixed eyes. ‘Shall I choose a name for you? Will you be called . . . Mary?’

  He touched her sleeve again to show her whom he was addressing; and very slightly, she inclined her head.

  ‘Idiocy. Five,’ he heard from McLeish’s table. ‘Aha. My final customer. This is a record time. It is not yet eight o’clock.’

  Thomas looked over Mary’s shoulder where his line of waiting women stretched out into the night.

  ‘Classification,’ said Miss Whitman sharply.

  ‘Mary,’ said Thomas. ‘Tell me how many fingers I am holding before your face.’

  Mary lowered her head and mumbled some inaudible word. Thomas saw that the top of her scalp was raw where she had scratched it.

  ‘Dr Midwinter! Will you please tell me what to write down for this woman!’

  ‘This woman,’ said Thomas, taking her hand as he spoke, ‘is blind.’

  It was half past one when he finally finished writing up his new admissions. The patients themselves had been classified by ten, but he wanted, beneath the pasted-in notes of the examining doctors, to note down his own impressions in the ledger, while they were still clear in his mind. One of the problems was the simple question of identity. The majority of the women he admitted would not be released and most of them would receive no medical consultation while they were in the asylum. In addition to Faverill and himself, there was one other doctor, also with the rank of assistant medical officer. His name was Stimpson, and Thomas was due to meet him in the morning.

  McLeish, it had transpired over a rushed supper in the kitchen, was not a doctor. After a spell in the county regiment, he had been the warehouse manager at a porcelain factory in Stoke-on-Trent, where he had shown unusual ability as an administrator. He had been hired by Faverill’s predecessor on the recommendation of the governing body, who were reluctant to pay for medical expertise. One doctor to six hundred patients was a not abnormal ratio in the English county asylums, they concluded, and while Faverill’s predecessor had the help of Stimpson, it was thought that a proven warehouseman would be more helpful than a third alienist.

  Even with the most rigorous schedule and the briefest of consultations, it was clear to Thomas that he would not be able to follow the course of six hundred illnesses, let alone devote to them the long-term observation they required. From what McLeish told him, it did not appear in any case that patients were assigned to any medical officer in particular.

  ‘Here, Captain.’ McLeish threw a piece of fat
to his dog, who sat beneath the table, while he, Grogan and Thomas were completing their supper.

  ‘Am I at least free to visit whichever patient I wish?’ said Thomas.

  McLeish laughed. ‘They don’t expect to be visited. They are not here to tell you the story of their lives, young man. In fact, it is because they cannot tell you the story of their lives that they have been sent to us!’

  ‘But I should like to find out more.’

  ‘You will find your time is full enough without trying to interfere with individual cases. There are six miles of madmen to be looked after. I think you will find that work enough.’

  Grogan held out his glass to be refilled from the jug of beer.

  ‘Are you prescribing hyoscine?’saidThomas. ‘I believe it has had some good results.’

  ‘What is it?’

  ‘It is a form of henbane, mightily toxic, but carefully administered it can bring relief in mania, I believe. Or paraldehyde? It is a sleeping medicine.’

  ‘I don’t know,’ said McLeish. ‘Ask Stimpson. Is paraldehyde the one that makes them smell? We don’t go in for treatments a great deal, that much I can tell you. From the last papers I had from the apothecary, I recall that the number of male patients taking physic was sixty-five out of nine-hundred-odd, and among the ladies it was seventy-nine out of almost eleven hundred.’

  ‘So that’s about . . .’

  ‘It is seven per cent.’

  ‘And for the others? What treatment are they receiving?’

  ‘They are receiving the treatment of the asylum,’ said McLeish. ‘They are given a safe home, free food and lodging; they are given tasks to perform in the grounds, the farm and the workshops. They are given exercise in the airing courts if they are not fit to work. They are given entertainments and distractions. Next Saturday evening they will have a visit from the Temperance Hand Bell Ringers.’

  Thomas did not wish to provoke McLeish, but he found his pride as a doctor a little scuffed by McLeish’s warehouse manner. ‘Do you not think we might do more from a medical point of view?’ he said.

  ‘“We are an asylum not a hospital,”’ said McLeish. ‘“We are a hospital only in occasional instances, but we are an asylum always.”’

  ‘Is that your belief?’

  ‘Yes,’ said McLeish. ‘And not only mine. I was quoting from the report of the chairman of the Committee of Visitors. You would do well not to forget what the word asylum means. From the Latin: a – without, sylum – cure. Get down, Captain.’

  Thomas suppressed the pedantic correction that occurred to him. ‘I accept what you say, Mr McLeish. I respect your experience here. But I shall follow my own hopes in this establishment.’

  ‘You can follow what you like, young doctor. We have our successes, our cures, do we not, Billy?’ Grogan nodded over his beer. ‘Some people do leave the asylum and return to their families. However, the weight of experience is the other way. More than ten years ago a state hospital in New York made it a point of policy that no patient should be discharged. They gave themselves the honourable task of acting as custodians. Most of the hospitals in the United States have begun to follow that example, and I think you will find that our American cousins have the habit of always being a wee bit in advance of us.’

  Thomas left them to it and returned to his room to complete his notes on the admissions. He had been given a cubicle between wards Seven and Six on the female side; the attendant who normally occupied it had been discharged when she became pregnant and was yet to be replaced. Faverill promised Thomas a better room in one of the towers, above the babel, when one became available.

  In addition to the narrow iron bed, there was a chest, a shelf and a writing table, on which Thomas had completed his notes by the light of an oil lamp. He put down his pen, rubbed his eyes and sat down on the edge of the bed. The question of identity. He could make small pencil sketches of each patient in the ledger, but it was hardly scientific. Who looked at the books, anyway? McLeish probably. The Committee ofVisitors. The Commissioners in Lunacy. They would not want to see Thomas’s ungifted draughtsmanship. He would have to write down brief, coded mnemonics to himself: red face, tremor, stench, scar; he could perhaps do it in Latin, in which language he would certainly escape detection by McLeish.

  Or photographs. Would Faverill permit photography? He had heard of an alienist in London who took pictures of the patients in his asylum because he was an amateur of physiognomy, who wished to demonstrate the importance of race, inter-breeding and cranial phenomena in the process of morbid degeneration. He himself might use photographs to a simpler end, he thought.

  He took a wash bag from his case and went quietly out, across Ward Seven to the bathroom, where he scrubbed his face and teeth. Back in his cubicle, he undressed, put on a night shirt and pulled up the blanket over him.

  To his ears, from the wards on either side, came the moans and jabberings of shipwreck.

  Oh Sonia, my sister, he thought. Oh Jacques, my dear friend. He tried to sleep, but his head was filled with the faces of lunatics, their palsied hands, their shattered eyes.

  There was a meeting after breakfast in Faverill’s office, and here Thomas met the third alienist, Stimpson, a black-jawed man of forty or so who smoked cigars and was interested in experimenting with different sedatives. He proposed that by default each patient should be dosed daily, unless obviously in the category of idiot or epileptic when such medicine would be either useless or harmful. Support was lukewarm – from McLeish in that he regarded his own methods of management as sufficient, and from Faverill in that the proposal lacked any diagnostic element. At the end of the meeting, also attended by Matilda, rocking by the fire, Miss Whitman, the senior ladies’ attendant, and by Tyson from the men’s side, the staff went their different ways.

  ‘Come with me, Midwinter,’ Faverill said, and showed him to the back of the building, where three high walls, together with the rear of the asylum, made a square that had been laid to grass.

  ‘Have you ever visited France?’ said Faverill.

  ‘Yes. I went with my sister to Deauville and I have a friend who is studying medicine in Paris. I have been to visit him.’

  ‘There is a pleasant hillside, a sort of barrow, I suppose, that overlooks the River Aisne. It is called the Chemin des Dames because it is where the ladies of the court of Louis XIV used to take their exercise. I sometimes think of it when I come into this airing court. Alas, the view to the river here is blocked by the wall, but I feel it is important for the women to have something charming to look at.’

  In the centre of the square was a decorative iron arch, up which wistaria was being encouraged; around it was a marquetry of gravelled paths and triangular beds with ankle-high box at the edge. A simple lawn enclosed this cultivated centrepiece, stretching to a path that went round the perimeter of the square; the lawn was spotted with dandelions and grew ragged at the edges where it ran into the brick.

  ‘One or two of them have cultivated flowers in the beds,’ said Faverill. ‘We cannot give them sharp implements, so it is a little haphazard. But I think it pleases them.’

  ‘It is admirable,’ said Thomas. ‘Very pleasant. And do the men have something similar?’

  ‘Yes, a similar space, but they grow vegetables. We wanted to install a greenhouse for them, but alas . . . The glass, you see.’

  There was the sound of locks being turned in a battered, green-painted door and twenty or so ‘ladies’ were ushered out into the airing court. An old white-haired woman, of the kind Thomas had seen a thousand times behind the counter of a confectioner’s shop or pulling a grandchild along the street, walked to a decided spot on the grass, squatted down and defecated. None of the women spoke to one another; most seemed to have locomotive routines that involved pacing round the perimeter at speed, with stretched, unnatural stride or else making intricate but repeated patterns of steps: two to the left, one back, one to the right; and repeat. Two kept up shrill unending narratives; one stretched
her neck and screamed. There was no horticulture that Thomas could see.

  The men’s airing court, to which Faverill next led him, was similar in the extent to which each man stood apart from the others. None attempted to communicate, and Thomas wondered if they noticed one another. One sat on the grass and rocked himself, with his temples between his hands, to an angle of about forty-five degrees each way; there were bald patches on the sides of his head where the insides of his wrists had rubbed away the hair. There was a rumbling of menace that had not been present on the female side, and when a stout, bearded man grabbed a vacant-looking youth by the throat and began to beat his head against the wall, a wail of fear ran through the court. The rocking man rocked harder and moaned under his breath; the striders at the edge strode faster, looking more fixedly ahead, and those measuring out their patterned steps did so with a whimpering precision that suggested that their safety depended on it. A scholarly-looking man of sixty or so put his hand down his trousers, pulled out the faeces that he found there and anxiously began to stuff them into his mouth, glancing guiltily this way and that as he did so. Two attendants took away the miscreant, and one of them gave the half-throttled youth a stick of liquorice.

  Faverill, who had a report to write, told Thomas to explore the grounds and the farm at his leisure and to take note of what he saw. ‘Come and report to me at five o’clock in my office when Matilda shall make us a cup of tea. A charming creature, is she not?’

  ‘Yes, sir,’ said Thomas.

  In Ward Four on the ladies’side he found Daisy, the young woman who had accosted him and Faverill the day before. His eyes met her impatient gaze as soon as he unlocked the door: she was sitting at the table in the middle of the room and sprang up when he entered.

  Thomas smiled. ‘Steady! I had not forgotten. First I need to tell someone that I am taking you.’ He signed a daybook at the request of an attendant then told Daisy to come with him, which she did, following so close to his heels that she tripped herself and stumbled as they left.

  When they found themselves in the open air, Daisy gave a jump of elation, and held on hard to Thomas’s arm, as though she feared someone might separate them and shove her back into the reeking atmosphere of the ward.