The Surgeon of Crowthorne

by Simon Winchester

  His prostate gave up on him in the spring of 1915, and the burning X-rays with which such problems were then treated hurt him severely. He kept up his pace of work, completing trink to turndown in mid-summer, and including many difficult words that, as a fellow editor said, ‘were handled with characteristic sagacity and resource’. He was photographed for the last time in the Scriptorium on 10 July – his staff and daughters around and behind him, and in the background shelves of bound books replacing the pigeon-holes with their thousands of slips of paper, which had been the familiar backdrop in the Dictionary’s earlier days. Sir James has his academic cap still atop his head, but he looks thin and weary; his expression is of calm resignation, the expressions of those beside him knowing and tragic.

  He died on 26 July 1915, of pleurisy, and was buried as he wished to be, beside a great Oxford friend who had been Professor of Chinese.

  Minor, now into his fifth year at the Government Hospital for the Insane in Washington, DC, would have heard in due course of the death of the man who had brought him so much solace and intellectual comfort. But on the actual day of Murray’s passing he merely had yet another of the bad days that he was increasingly now enduring. Some might say that it was a day on which Minor in Washington was unknowingly in sympathy with the sad events that were unfolding in Oxford, more than 3,000 miles across the Atlantic Ocean.

  ‘Struck one of his fellow patients,’ read the notes of Minor’s Cherry Ward for that same Monday evening, 26 July. ‘He had happened to stop and look into his room. Shows temper and will try to strike hard, but has little strength to hurt anyone.’ (He had started hitting people the month before. He went walking one June afternoon, along with his attendant, and the pair met a policeman. When the officer began to ask questions, Minor started pounding the attendant on the chest – though he later said he was sorry, and explained that he was becoming ‘a little excitable’.)

  He had probably been capable of inflicting little hurt from the moment he was first entered in the hospital log. He may have been mad, but he was painfully slender, his spine was bowed, he shuffled as he walked, he had lost his teeth and had alopecia. He had photographs taken, full on and in profile, as if he were a common criminal: his beard is long and white, his bald head high and domed, his eyes wild. His madness was defined as simple paranoia, the doctors said; he admitted that he still thought constantly about little girls, and that he had dreams about the appalling acts that they forced him to perform during his forced nightly excursions.

  But he was not regarded as dangerous: his doctors agreed that he should be granted the privilege of walking into the surrounding countryside, if accompanied by an attendant. The stump of his penis attested dramatically to the fact that he should not be allowed access to either a knife or to scissors. But otherwise, he was deemed harmless – he was just an 81-year-old man, thin, toothless, wrinkled, slightly deaf and only ‘very active, considering his age’.

  His delusions steadily worsened during the St Elizabeth’s years. He complained that his eyes were regularly pecked out by birds, that people forced food into his mouth through a metal funnel and then hammered on his fingernails, that scores of pygmies hid beneath the floorboards of his room and acted as agents for the Underworld. He was occasionally irritable, but more usually quiet and courteous, and he read and wrote a great deal in his room. He had a somewhat arrogant air, said one doctor; he did not much care for the company of his fellow patients, and he would absolutely not let any one of them go into his private room.

  It was at St Elizabeth’s that his hitherto puzzling illness was given what might be regarded as its first modern, currently recognizable description. On 8 November 1918 his attending psychiatrist, a Dr Davidian, formally declared that William Minor, Federal Patient Number 18487, was suffering from what was to be called ‘dementia praecox, of the paranoid form’. No longer was the vague word monomania to be used, nor would simple paranoia do. Minor and his case-history had been finally cast off from the dubious moorings of the Victorians’ puzzled but determinedly ‘moral treatment’ of the mad – the phrase had been coined by the Frenchman Philippe Pinel of La Salpêtrière in Paris – and were at last to be welcomed into the world of modern psychiatry.

  The new phrase, dementia praecox, was quite precise. By the time Davidian employed it as a diagnosis it had been current for twenty years. It literally meant ‘early-flowering failure of the mental powers’, and was used to distinguish a condition in which a person begins to lose touch with reality, as Minor had done, early on in his life – in his teens, his twenties or his thirties. In this sense the illness was markedly different from senile dementia, a term once used to describe the decrepitude that specifically accompanies old age, and of which Alzheimer’s Disease is one kind.

  The nomenclature was published in Heidelberg in 1899 by the German psychiatrist Emil Kraepelin, who at the time was the supreme classifier of known mental ills. His naming of the condition was designed less to distinguish it from being an old person’s ailment, as to mark it as very different from manic-depressive psychosis, an illness that had enough similarities to confuse the earliest of the alienists.

  Kraepelin’s view, revolutionary at the time, was that while manic-depressive psychoses had identifiable physical causes (such as a low level of the alkali metal lithium in the blood and brain), and were thus treatable (as with the use of lithium, for example, to top up a depressive’s lack of it), dementia praecox was a so-called endogenous ailment, quite lacking in any identifiable external cause. In that respect it was to be regarded as similar to such enigmatic systemic physical disorders as essential hypertension, in which a patient develops high blood pressure – and its many untidy and inconvenient side effects – for no obvious reason.

  Kraepelin went on to define three distinct sub-types of dementia praecox. There was catatonic, in which the motor functions of the body are either excessive or non-existent; hebephrenic, where grotesquely inappropriate behaviour begins during puberty, hence the word’s origin from the Greek ήβη, youth; and paranoiac, in which the victim suffers from delusions, often of persecution. It was from this kind of dementia, according to Kraepelin’s classification of the time, that Minor was suffering.

  The traditional treatment offered to him and his kind was still simple, basic and, by today’s standards, dismayingly unenlightened. Those suffering from paranoid dementia were deemed pathologically incurable, were removed from society by order of court and were placed – kindly, tenderly, for the most part, thanks to Pinel’s powerful influence – in cells behind high walls, so as to cause no inconvenience to those living in the normal, outside world. Some were incarcerated for only a very few years; some for ten or twenty. In the case of Minor his involuntary exile from society was to last for most of his life. He existed for most of his first thirty-eight years on the outside, until he killed George Merrett. Then for forty-seven of the forty-eight years that were left to him he was locked away in state asylums, essentially untreated because he was, in the view of the doctors of the day, essentially untreatable.

  Since the time of Minor and Davidian the illness has become much more liberally regarded. Its name, for a start, has changed: what was initially the far less daunting word schizophrenia – it came from the Greek for split mind – made its first appearance in 1912. (It may change again: to rid the ailment of its patina of unpleasant associations, there are now moves to have it called Kraepelin’s Syndrome.)

  Early treatments for the disease, which were just being introduced at the time of Minor’s final decline, involved the use of massive sedatives like chloral hydrate, sodium amytal and paraldehyde. Today entire shelves of costly anti-psychotic drugs are available to at least treat and manage schizophrenia’s more discomforting symptoms. But so far, and despite the spending of fortunes, there have been precious few advances in staying the mysterious triggers that seemingly set off the illness and its demonic mischiefs.

  And there continues to be much debate about what these triggers mi
ght be. Can it ever be said that a major psychological illness like schizophrenia, with its severe disruption of the brain’s chemistry, appearance and function, truly has a cause? In the case of Minor – could the terrible scenes at the Battle of the Wilderness actually have triggered his florid behaviour?

  Might his branding of an Irishman have precipitated, led directly, or contributed even indirectly, to the crime that he committed eight years later, and that led to the exile he was to suffer for the remainder of his life? Was there ever an identifiable happening, was he ever exposed to the mental equivalent of an invading germ? Or is schizophrenia truly causeless, a part of the very being of some unfortunate individuals? Moreover, what is the illness – is it simply the development of a personality that is several steps beyond mere eccentricity, and that steps into areas which society does not find itself able to tolerate or approve of?

  No one is quite certain. In 1984 a paper was presented describing a man who firmly believed himself to have two heads. He found one of them irritating beyond endurance, and shot at it with a revolver, injuring himself terribly in the process. He was diagnosed as schizophrenic, and the psychiatric community agreed, since it was manifestly certain that the man only had one head, and suffered and was dominated by an absurd delusion. But then again, the notorious ‘Mad Lucas’ of Victorian Hertfordshire – who lived with his wife’s dead body for three months, then by himself, in wild biblical solitude and squalor for the next quarter century, and was visited by coachloads of trippers up from London for the day – was diagnosed as schizophrenic too. Should he have been? Was he not merely a borderline eccentric, behaving in a fashion beyond the accepted norms? Was he as mad as the deluded owner of the phantom head? Was he as dangerous, and as deserving of confinement? And how does a case like Minor’s sit within the spectrum of this madness? Was he less mad than the first man, and more so than the second? How does one quantify? How does one treat? How does one judge?

  Psychiatrists today remain cautious about all of these questions, and remain puzzled and argumentative about whether the illness can be triggered, whether it does have a definable cause. Most academic psychiatrists hedge their bets, avoiding dogma, preferring simply to say they believe in ‘the cumulative effect of a number of factors’.

  A patient may have a simple genetic predisposition to the illness. Or he may have characteristics of his basic temperament that similarly increase the likelihood that he will ‘react badly’ or floridly to an external stress – to the sights of a battlefield, to the shock of a torture. But perhaps certain sights and the ensuing shocks are too great, or too sudden, for anyone to endure them and remain wholly sane.

  There is the newly recognized condition known as Post-Traumatic Stress Disorder, which seems to affect inordinately large numbers of people who have been exposed to truly appalling situations. The only difference between their cases today, after the Gulf War where it was first identified en masse, or after the trauma of a kidnap or a traffic accident, and those of the past is that most sufferers become relieved of their symptoms after a period of time. William Chester Minor never was. His agony endured for his entire life. However convenient it may be to say that Post-Traumatic Stress ruined his life, and that of his victim, the continuing symptoms suggest otherwise. There was something wildly wrong with his brain, and what happened in Virginia probably prompted its more ruinous manifestations to emerge.

  Perhaps it was an unusual genetic make-up that predisposed him to fall ill – two of his relations had killed themselves, after all, though we are not certain of the circumstances. Maybe his gentle temperament – he was a painter, a flautist, a collector of old books – made him unusually vulnerable to what he saw and felt on those blood-soaked fields in the South. Maybe his subsequent imprisonment in Broadmoor then left him unimproved, when a more compassionate and enlightened regime might have mitigated his darker feelings, might have helped him recover. One in a hundred people today suffers from schizophrenia: nearly all of them, if treated with compassion and good chemistry, can make a fist of some kind of dignified life, of a kind that was denied, for much of his time, to Minor.

  Except, of course, that Minor had his Dictionary work. And there is a cruel irony in this – that had he been treated with today’s compassion and good chemistry, he may never have felt impelled to work on it as he did. By offering him mood-altering sedatives, as they would have done in Edwardian times, or treating him as today with such anti-psychotic drugs as Quetiapine or Risperidone, many of his symptoms of madness might have gone away – but he might well have felt disinclined or unable to perform his work for Murray.

  In a way, those Dictionary slips were his medication, they became his therapy. The routine of his quiet and cell-bound intellectual stimulus, month upon month, year upon year, appears to have provided him with at least a measure of release from his paranoia. His sad situation only worsened when that stimulus was gone: when the great book ceased to function as his lodestone, when the one fixed point on which his remarkable but tortured brain was able to concentrate became detached, so then he began to spiral downwards, and his life to ebb.

  One must feel a sense of strange gratitude that his treatment was never good enough to divert him from his work. The agonies that he must have suffered in those terrible asylum nights have granted us all a benefit, for all time. He was mad, and for that we have reason to be glad. A truly savage irony, on which it is discomfiting to dwell.

  In November 1915, four months after Sir James had died, Minor wrote to Lady Murray in Oxford, offering her all the books that had been sent from Broadmoor to the Scriptorium, and that had been in Sir James’s possession when he died. He hoped they might eventually go off to the Bodleian Library. ‘I am glad… to know that you are well, as I must presume from your letter and occupations. You must be taking or giving a great deal of labour for Dict’y materials still.’ And his books do indeed rest in the great library to this day: they are registered as having been donated ‘By Dr Minor through Lady Murray’.

  But by now he was failing steadily. An old colleague from Civil War days wrote from West Chester, Pennsylvania, to ask how his friend was – and the hospital superintendent replied that, considering his years, Captain Minor was in good health, and was in a ‘bright and cheerful ward, where he seems contented with his surroundings’.

  But the ward notes tell a different story, presenting as they do a litany of all the symptoms of the steady onset of senility and dementia. With increasing frequency the attendants write of Minor stumbling, injuring himself, getting lost, losing his temper, wandering, growing dizzy, tiring easily – and, worst of all, beginning to forget, and to know that he was forgetting. His mind, though tortured, had always been peculiarly acute: now, by 1918 and the end of the Great War, he seemed to understand that his faculties were dimming, that his mind was at last becoming as weakened as his body, and that the sands were running out. For days at a time he would stay in bed, saying he needed ‘a good rest’; he would barricade the door with chairs, certain in his persecution. It was more than forty-five years since the murder, fully half a century since the first signs of madness had been noticed, back at the Florida army fort. And yet the symptoms remained the same, persistent, uncured, uncurable.

  Still came the occasional querulous note, such as this, written in the summer of 1917:

  Dr White – Dear Sir, There was a time when the meat – beef and ham – was very tough and dry. This has in a degree altered for the better since your note even, and I would not complain of that: and rice seemed to be the only vegetable with it.

  This is not much to complain of: and yet these trifles are much to us in this life.

  Thanking you for what you would wish to do.

  I am very truly yours

  W. C. Minor

  A year later – though his failing memory and eyesight cause him to date the letter 1819 rather than 1918 – he shows another strange spurt of benevolence, similar to his contributing to Murray’s adventure to the Cape. In this l
atest case he sent twenty-five dollars to the Belgian Relief Fund, and a further twenty-five to Yale University, his alma mater, as a donation to its military service fund. The Yale President wrote back from Woodbridge Hall: ‘I have known much of Dr Minor’s history,’ he replied to the superintendent, ‘and am therefore doubly touched to receive this gift.’

  In 1919 his nephew, Edward Minor, applied to the army to have him released from St Elizabeth’s and brought to a hospital for the elderly insane in Hartford, Connecticut, known as the Retreat. The army agreed: ‘I think if the Retreat fully understands the case we should let him go,’ said a Dr Duval, at an October conference to discuss the matter. ‘He is getting so old now he will probably not do much harm.’ The hospital board agreed too, and in November, in a snowstorm, the frail old gentleman left Washington, and the strange world of insane asylums – a world that he had inhabited since 1872 – for good.

  He liked his new home, a mansion set in acres of woods and gardens on the banks of the Connecticut River. His nephew wrote in the early winter of 1920 of how the change seemed to have done him some good, and yet at the same time of how incapable he was of looking after himself. Furthermore, he was fast going blind, and for some months had been unable to read. With this one overarching source of joy now denied to him, there must have been little left to live for. No one was surprised when, after a walk on a blustery early spring day in that same year, he caught a cold that turned into bronchiopneumonia, and died peacefully in his sleep. It was Friday, 26 March 1920. He had lived for eighty-five years and nine months. He might have been mad, but, like Dr Johnson’s Dictionary elephant, he had been extremely long lifed.