'That's good. Weather like this, you have to be careful. Stay away from stress.'
'Absolutely,' said Mainwaring, searching the detective's face for hidden meaning. Milo responded with a blank stare.
'Is there anything else I can help you with, Sergeant?'
'We were talking about PCP,' said Milo.
'What would you like to know about it?'
'For starters, how well it mimics schizophrenia.'
'That's an extremely complex question. Phencyclidine is a fascinating agent, very poorly understood. No doubt the primary site of activity is the autonomic nervous system. However - '
'It drives people crazy, doesn't it?'
'Sometimes.'
'Sometimes?'
'That's correct. Individuals vary greatly in their sensitivity. Some habitual PCP abusers experience euphoria; others become acutely psychotic after a single dose.'
'Psychotic as in schizophrenia?'
'It's not that simple, Sergeant.'
'I can deal with complexity.'
'Very well.' Mainwaring frowned. 'To discuss schizophrenia intelligently, one must bear in mind that it isn't a single disease entity. It's a collection of disorders, with varying symptom constellations. Moderate-dose PCP reactions conform most closely to the type we call catatonia - disturbances of body posture and speech. But even catatonia is divided into subtypes.'
He stopped, as if waiting for his words to crystallise. Hoping he'd said enough.
'Go on,' said Milo.
'What I'm trying to emphasise is that phencyclidine is a complex drug with complex, unpredictable reactions. I've observed patients who manifest the mutism and grimacing of stuporous catatonia, others who display the waxy catalepsy of classical catatonia - they become human manikins. The ones you'd he most likely to come into contact with display symptoms that uncannily resemble an agitated catatonia: psychpmotor agitation; profuse but incoherent speech; destructive violence directed against the self and others.'
'What about paranoid schizophrenia?'
'In some patients large doses of phencyclidine can cause auditory hallucinations of a paranoid nature. Others respond to high-dose abuse with the kind of grandiosity and
hyperactivity that leads to a false diagnosis of unipolar affective psychosis - mania, in lay terms.'
'Sounds like a hell of a psychotomimetic to me, Doc'
'In the abstract. But by itself that's meaningless. All the commonly abused drugs are potentially psychotomimetic, Sergeant. Amphetamines, cocaine, barbiturates, hashish. Even marijuana can cause psychotic symptoms when ingested in sufficient dosage. That's precisely why any psychiatrist worth his salt will observe his patient carefully and test for drug history and the presence of narcotics in the system as a differential prior to establishing the diagnosis of schizophrenia.'
'That kind of screening is routine?'
Mainwaring nodded.
'So what you're saying is that although drug reactions can mimic schizophrenia, it would be hard to fool a doctor.'
'I wouldn't go quite that far. Not all doctors are sophisticated about psychoactive agents. An inexperienced observer - a surgeon, a general practitioner, even a psychiatric resident who lacked familiarity with drugs -might conceivably mistake drug intoxication for psychosis. But not a board-certified psychiatrist.'
'Which is what you are.'
'Correct.'
Milo got up from the couch, smiling sheepishly. 'So I guess I've been barking up the wrong tree, huh?'
'I'm afraid so, Sergeant.'
He walked over and looked down at Mainwaring, put away his pad, and began extending his hand. But just as the psychiatrist started to reciprocate, he pulled it back and scratched his head.
'One more thing,' he said. 'This routine screening, does it include anticholinergics?'
The pipe in Mainwaring's mouth trembled. He used one hand to hold it still, then removed it and made a show of examining the tobacco within.
'No,' he said. 'Why would it?'
'I've done a little research of my own,' said Milo.
'Found that atropine and scopolamine derivatives have been used to drive people crazy. By South American Indians, medieval witches.'
'The classic belladonna potion?' said Mainwaring offhandedly. Both hands were shaking now.
'You got it.'
'Interesting concept.' The pipe had gone out, and it took three matches to relight it.
'Isn't it?' Milo smiled. 'Ever seen it?'
'Forced atropine intoxication? No.'
'Who said anything about forced?'
'I - we were talking about witches. I assumed you - '
'I meant any type of atropine intoxication. Ever seen it?'
'Not for years. It's extremely rare.'
'You never did any research or writing about it?'
The psychiatrist grew reflective.
'Not to my recollection.'
Milo cued me with a look.
'There was an article in The Canyon Oaks Quarterly,' I said, 'about the importance of screening elderly patients for anti-cholinergics so as not to misdiagnose senile psychosis.'
Mainwaring bit his lip and looked pained. He stroked the stem of his pipe and answered in a low, shaky voice.
'Ah, yes. That's true. Many of the organic anti-Parkinsonian agents contain anticholinergics. The newer drugs are cleaner in that regard, but some patients don't respond to them. When the organics are used, medical management can get tricky. The article was intended as a bit of continuing education for our referral sources. We try to do that kind of - '
'Who wrote it?' asked Milo, staring down at the psychiatrist.
'Dr. Djibouti did.'
'All by himself?'
'Basically.'
'Basically?'
'I read an early draft. He was the primary author.'
'Interesting,' said Milo. 'Seems we have a little discrepancy. He says you collaborated. That the original
idea was yours, even though he did most of the writing.'
'He's being gracious.' Mainwaring smiled edgily. 'The loyalty of an associate. In any event, why the fuss over a little - '
Milo took a step closer, so that the psychiatrist had to crane his neck to look up at him, put his hands on his hips, and shook his head.
'Doc,' he said softly, 'how about we cut the crap?'
Mainwaring fumbled with the pipe and dropped it. Ashes and embers scattered on the carpet. He watched them glow, then die, looked up with the guilty terror of a child caught masturbating.
'I have absolutely no idea - '
'Then let me explain it to you. Just a couple of hours ago I had a meeting with a whole bunch of specialists at County Hospital. Professors of medicine. Neurologists, toxi-cologists, bunch of other ologists. Experts, just like you. They showed me lab reports. Drug screenings. Explained everything in terms a cop could understand. Seems James Cadmus has been systematically poisoned with anticholinergics. For a long time. During the period he was under
