‘And how is Mr Oldershaw?’
‘In terms of his eventual progress towards a cure, I have great hopes of him. His constitution is robust, and his temperament naturally sanguine. His family and friends wish him all that is good. There is no lack of resources. In short, I have seen many patients in far worse circumstances. Indeed, I have had some of them under this roof.’
‘I do not doubt it,’ Holdsworth said.
‘Nor, in some respects, is his case uncommon. There are many young men who come up to the University ill-prepared to meet the temptations and trials that they find here. Some have never been away from home before. Without firm guidance or, in many cases, the support of carefully inculcated moral principles, they unite the follies of youth with the opportunities of independence and, by degrees, slide towards catastrophe.’
‘You speak generally, sir,’ Holdsworth said. ‘But what of Mr Oldershaw?’
For the first time Dr Jermyn hesitated. ‘Pray, sir, what exactly have they told you? I would not have you meet him unprepared.’
‘I have seen Mr Cross’s neck.’
‘Ah. That was indeed unfortunate.’
‘Her ladyship informs me that her son’s temperament from his earliest years has been mild and good-humoured.’
A noise broke out somewhere above their heads, a distant howling, followed by rapid footsteps and the slamming of a door.
‘One must allow for a mother’s partiality,’ Jermyn said. ‘I should perhaps preface my remarks by saying that there are aspects of Mr Oldershaw’s case which may not be easily comprehensible to those who are not physicians. Indeed, sir, I suspect that perhaps even the majority of my professional brethren would be quite at sea. Only a physician who has made a particular study of maniacal disorders is really in a position to appreciate the finer points.’
‘Then pray allow me to manage as best I may with the coarser ones, sir. Why was he brought to you and not to some other medical man in the locality?’
Jermyn stared down at his hands, which were small, white and very clean. Then, perhaps recollecting who was paying the bills, he looked up with a smile.
‘Why, as to that, there are not so many of us who specialize in such cases within easy reach of Cambridge. I flatter myself that my name is not unknown in the University. The local physicians, though many of them are admirable men, have not had time or opportunity to study such conditions, let alone the modern science of moral management.’ Jermyn nodded, as if in approval of himself. ‘We have come a long way since the days of our grandfathers.’
‘And who recommended you to Lady Anne?’
‘Why, the lad’s tutor – Mr Richardson. It seems that Mr Oldershaw had not been himself for several weeks – since February. I wish they had called me in earlier. They waited until his condition had worsened considerably. That was in March.’
‘And what precisely was his condition?’
Jermyn joined his hands together and made a steeple of the fingers. ‘To put it simply, in lay terms, his melancholy had deepened to the point where he found life insupportable. The proximate cause appears to have been a nervous collapse within one portion of the brain, inducing a form of delirium. Now, we physicians distinguish in these cases between melancholia and mania. Some believe that the two conditions are generically separate, but I hold with Professor Cullen that in fact the difference between them is not one of kind but only of degree. If you consult his Nosology of Mania you will find the doctrine explained in great detail.’
Holdsworth thought of Maria: of the effect on her of Georgie’s loss, and then of the news that she must leave the house where he had lived and where they had brought his battered little corpse: in Jermyn’s terms, when melancholia had slipped into mania. ‘You do not think there was a particular, external cause? A shock of some sort to his system?’
‘I do not say that precisely. It is rather that I look to the physiology of the brain to provide my answers, rather than to any events, real or imaginary, that may or may not have taken place outside it.’
‘And so what of the ghost?’
‘Ah – our ghost.’ Jermyn smiled again. ‘I wondered when we might arrive at this fabled creature. My dear sir, it is a symptom of Mr Oldershaw’s mania, not a cause.’
‘I am informed that Mr Oldershaw was walking in the garden at Jerusalem late one night, and that he believed he saw the ghost of a lady who had recently died, a lady with whom he was acquainted as she was the wife of a friend. And it was this that drove him to attempt to take his own life.’
‘That is to put the cart before the horse. Consider his unprovoked attack on Mr Cross. Here we have his mother’s steward, an old man he has known since childhood. Mr Cross barely had time to enter the room where Mr Oldershaw was sitting when the young man leaped up and attacked him. Had not an attendant and myself been at hand to restrain him, the consequences for Mr Cross might have been fatal. There is no conceivable external reason why Mr Oldershaw should have attacked him, any more than there is any reason why he should have attempted to destroy himself in the college pond. No, in both cases he was in the grip of the delirium of mania. The technical phrase for it is mania furibunda; that is to say, mania attended by violence.’
‘Let us not be technical for a moment, sir,’ Holdsworth said. ‘Had anything happened to make him believe Mr Cross was his enemy?’
‘Not as far as I know.’ The doctor leaned forward. ‘Sir, I cannot yet fully explain these particular manifestations of mania, but I believe I know the general phenomenon that makes them possible. You are perhaps familiar with Locke’s Essay upon Human Understanding?’
‘I have glanced over it, yes.’
Jermyn permitted himself another smile. ‘Inter alia, it deals with how we discern, and other operations of the mind. And Mr Locke makes acute remarks on the subject of why madmen fail to discern matters correctly. In fine, he argues that madmen are perfectly capable of rational thought. In this, by and by, they differ from idiots, who are constitutionally incapable of reasoning.’ The physician’s voice had imperceptibly acquired the inflections of the pulpit. ‘But for madmen, the difficulty arises from the propositions they reason from, rather than -’
‘Forgive me, sir, but I do not understand how a philosophical error could result in Mr Oldershaw’s mania,’ Holdsworth said. ‘And I am also puzzled to understand what his physiology has to do with it.’
‘You have strayed into the province of the physician, sir, and I’m afraid some confusion is inevitable. It is usually safe to take Mr Locke as a guide on such matters. Believe me, when you have seen as many of these unfortunate young men as I have, Mr Locke’s theories may not seem so improbable.’
‘But you are still unable to attribute a cause to his mania? That is the long and the short of it.’
‘ I’m interested in the fact of Mr Oldershaw’s delusions, not their content. In general, the ravings of a madman signify no more than the wanderings of a will-o’-the-wisp, and tracking the course of their vagaries is equally beside the point. What does signify, however, is the fact that he is raving. Like everything in the universe, from the orbit of the sun to the migration of swallows, melancholia and mania follow immutable laws. Such laws are like the master keys that permit us to unlock the mysteries of nature, including those of the human mind. They are all we need.’
‘And all Mr Oldershaw needs is to recover his senses,’ Holdsworth said. ‘What course of treatment do you follow, sir?’
‘I practise a system of moral management. I believe it the only effective way. The physician must achieve a benign domination over his patient, both in the psychological and the physical spheres. Once this is done, he can set to work on the defects of understanding that lie at the heart of the patient’s malady. Much depends on the physician’s ability to master his patient. It is not unlike training a child.’