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While Dr. Kearns could win awards for being a nasty piece of work, we might argue that Dr. J. F. Starr is the true villain in our story. As the director of Motley Hill Sanatorium he keeps his patients in inhumane conditions, and fails to see any problem with it:
"Warthrop," replied Starr in a condescending tone. "Really. These… " He waved his mottled claw in the air, searching for the word. "Patients, so-called, they are the dregs of society. They come here because there is literally no place else for them to go. No family, or none that would claim them. All are insane—most criminally so, and those who are not have the intellectual capacity of a turnip root. They are human garbage, discarded by men, toxic to the general populace and to themselves, forgotten, unwanted, cruel, comical mockeries of all things that make us human. They could rot here or they could be sacrificed to the higher good." (13.102)
That's not exactly the attitude a doctor should have toward his patients, especially if said doctor is professing to be a psychologist. Ugh. This lack of compassion toward the insane (or those assumed to be crazy—who's to say if anything is actually wrong with them with this guy doing the diagnosing) is what allows him to justify feeding so many poor people to the Anthropophagi on a regular basis. That, and the fact that he's being paid handsomely to do so.
To make things even worse (yup—they can get worse), he holds Captain Varner captive for over twenty years in conditions that lead to him being slowly eaten alive by maggots in his festering bed sores. After Varner's dead, Dr. Warthrop asks Dr. Starr why he didn't just send him to the Anthropophagi and be done with it, to which Dr. Starr responds:
"Dear God, Warthrop, what do you take me for? I may be avaricious, but I am not completely corrupt." (13.129)
Um… you sure about that? Thankfully, Dr. Starr's self-defense gets cut short by Dr. Kearns killing off that corrupt waste of space. Thanks, Kearns.