Dr George Savage
October 16th, 1885
Royal Bethlem Hospital
There is nothing in the world more soothing than a strong cup of coffee coupled with a light read. I consider the newspaper in front of me longingly for a moment before pushing it aside, and open Lady Stanbury’s case file.
Emotional side of Lady Stanbury uncontrolled, a tendency to mood swings, verbal and physical violence, marred by restlessness. Hallucinations ceased, yet delusions very much in force. Attempted to escape this morning, disturbing other patients and frightening staff. Threw a full chamber-pot of faeces over an attendant. Reached for a broken shard, unknown whether she harbored intention to do harm. To remain in isolation until behavior improves. Currently restrained in strong clothing for as short a period as necessary; whilst she is a danger to herself and others. Lunacy Commissioners informed.
The law requires that during the first three months of a patient’s admission, I make an entry into this book every week. After that, once a month, and after that, once every three months. However, given my newest patient’s current behavior, I find myself writing inside it much more often than required, as I do not wish to incur a twenty pound fine.
Gone are my mornings of a good, hearty breakfast accompanied by news of lighter matters.
I finish the paragraph and blow on the paper, the ink drying perfectly. That should make the commissioners happy. A tidy read portrays an organized hospital.
I tap my pen against the desk, thinking.
Prescribing Croton Oil.
Attention to the bowels can be of great service to these particular patients, though in Lady Stanbury’s case I am eager to examine her uterus. Yet…
Patient will not let me perform a physical assessment. Hydrotherapy may be useful in calming her enough for me to do so, slowing the blood flow to her brain and thus decreasing mental and physical activity.
To review patient afterward.
A loud knock on my office door startles me, causing me to drop my pen.
“Doctor?” Nurse Ruth leans through the gap. “Sir, Lord Damsbridge, and a Mr Stanbury are here.”
“Send them in, please. And bring the tissues, too, as this will stain.” I’ve asked her before to knock more quietly.
She peeks at the widening ink-stain and grimaces, turns on her heel, and exits the room. Seconds later the aforementioned gentlemen enter.
I glance at the paper. If I am unable to read it, it can still be put to use.
I throw it over the ink stain.
“My Lord, Mr Stanbury. Good morning to you both.”
“And to you, Doctor,” says Lord Damsbridge, shaking off his umbrella. His eyes search my office.
“In the corner-”
He deposits it in the stand before I can finish.
The recently bereaved husband stands back and off to one side with his hands in his pockets. His face is as grief stricken and apt to the occasion as his stance as he glares at the certificates upon my wall.
“Mr Stanbury, I don’t believe we have met.”
“Indeed not. And I must say, I would rather have preferred it stayed that way.” His gaze moves toward me as he answers, but his body remains still.
Generally, people dislike meeting me. The policemen because they believe I ‘save’ guilty men and women from the gallows. The patients, because they are terrified I’m going to throw them in a cell and let them starve. The relatives, because they don’t understand why their loved ones are locked away from society. Other doctors, who sneer in disdain at alienists.
It would affect a lesser man than I, of that I have no doubt.
“I agree. It is most unfortunate that this has occurred, and I offer you my most sincere condolences.”
He grunts in acknowledgment, nodding.
“Excuse my son-in-laws’ rudeness, Doctor,” says Lord Damsbridge, helping himself to a chair. “Stanbury, sit.”
“Oh, I’m not at all offended, My Lord-”
The Earl interrupts me.
“Well, you should be. A true gentleman should know how to act despite, or perhaps, because of his grief.” He stops, and peers around the chair. “Stanbury, I’m not going to tell you again.” He turns back to me, and offers a small, secret smile. “I keep telling him Doctor, an attitude like that doesn’t exactly inspire endearment from others.”
Mr Stanbury shoots a look of hatred towards the back of his father-in-laws head, but acquiesces.
“My apologies. I fear I am not myself. My wife did murder my baby less than two weeks ago, so you’ll have to excuse me.” His anger is palpable.
“Completely understandable, Mr Stanbury. Now, could I offer you gentlemen a coffee?”
Lord Damsbridge interrupts his son-in-law.
“Something stronger would be more appropriate at this time. Whiskey, perchance?”
I glance at the large grandfather clock, left here by my predecessor. I assume he’s referring to the meetings impending subject matter, as opposed to the hour, as the hands show only nine and twenty.
“Well, of course. I’m sure Nurse Ruth can fetch some, that woman can find anything given half a chance. She should be back momentarily, as I spilled-”
It’s best I keep my inherent clumsiness to myself.
“You were saying, Doctor?”
Opportunity presents itself in the personification of my attendant, as she knocks on the door and peers questioningly at me through the gap.
“Yes, come in, Nurse Ruth. I was saying, gentlemen, that when you let women into a mans domain, they tend to get carried away with their curiosity. Take this one here, for example: liked the look of my pen, and decided to write a note to her husband with it. And look at what she did!” I remove the newspaper with a flourish. “This is solid oak, gentlemen. Ruined, by romantic sentimentality in a flash.” I press my finger into the ink pointedly.
Her mouth drops open, but she quickly recovers.
“Yes, I am such a stupid woman,” she says, the sarcasm lost on the two men. She shakes the tissues in her hand, and advances. “Here, let me clean that.”
I wave her away.
“No, Nurse Ruth. I shall buy a new desk. You can repay me by finding our gentlemen here a bottle of our finest whiskey.”
“Certainly. Nice to meet you, My Lord. Mr Stanbury.” She curtseys, and leaves the room quietly, shutting the door with a small click.
“Women,” I say, laughing.
“Quite,” says Lord Damsbridge.
I reach into the desk and pull out Lady Stanbury’s folder.
“Right. I requested your company today so I may learn more of Lady Stanbury: her habits, friendships, personality, etcetera, in order to start appropriate treatment. This is a two way discussion, and I welcome any questions from you both.” As they nod in synchrony, Lord Damsbridge more so than the other, I continue onward with the speech I give to the relatives of every new patient admitted.
“Let me allay any fears you may have with regards to Lady Stanbury being in, dare I say it: a lunatic asylum.” I raise my eyebrows in an imitation of mock horror. “Forget the histrionic stories that old wives exchange on street corners about madmen being chained to the walls. This is the nineteenth century gentlemen, and our field of expertise is much more advanced than that which prescribed the inhumane and inexperienced treatments of yesteryear.”
“Though it remains true that the people in here are lunatics, does it not, Doctor?” Mr Stanbury says, spitefully.
“Well, yes – some of them, but Bethlem is a place of rest where anyone suffering mental deficiency can come to be treated. We even have people admit themselves voluntarily, of their own will.” I sift through the drawer of my desk again, and pull out a form. I put the paper in front of the gentlemen and reach for my pen. Ah, it is covered with ink. I fumble discreetly for a spare whilst the men read over the sheet. “Cast your eyes over the writing at the top.” Aha. A pen. I pull it out and tap it over the paragraph I want them to read. “It says: ‘All persons, of unsound mind presumed to be curable, are eligible for admission into this hospital for maintenance and medical treatment’”.
“Presumed ‘curable’?” Lord Damsbridge asks, eyebrows raised.
“Yes,” I say, pleased he focused on that word. “She can be cured completely.”
“Cured of what, precisely? What is wrong with her? Why did she kill our eight week old son?” Mr Stanbury says, his jaw set tight.
We are interrupted by the door opening, and Nurse Ruth makes her way inside carrying a silver dish. Atop lay a crystal decanter, three glasses, and a bottle of Tullamore Dew.
“Good choice,” says Lord Damsbridge, lifting the whiskey and pouring two generous measures. Handing one to Mr Stanbury, he looks at me.
“For you, Doctor?”
“I’m a coffee man, myself.”
He frowns, disapprovingly.
“But I do enjoy a little indulgence from time to time,” I lie, as he fills a third glass.“Yes, I would like one after all, thank you.” I lift the golden liquid to my mouth, loathe to taste that which leads to perversion of the mind. I sip it tentatively, and it travels down my throat like liquified nails.
Mr Stanbury has drank his fill before I lifted the glass to my lips.
I swirl the liquid, and place it on the desk.
“To answer your question, Mr Stanbury, your wife is suffering from a mental illness called ‘Puerperal Mania’. I believe you have both heard this term before, at the time of her first assessment shortly following her arrest on October 5th, 1885. I stand by that diagnosis. Puerperal Mania, in Lady Stanbury’s case, is the cause of her insanity. Just as others may go mad because of epilepsy, or alcohol, or fever; pregnancy and childbirth has caused Anne to become temporarily insane.
“My Lord, Puerperal Mania tends to have an element of inheritance. Indeed, it is the chief cause: pregnancy itself being only a secondary factor. How did your wife fare after giving birth? Can you remember whether she displayed any signs of seeing to the baby too much, or too little? Did she retreat to her bed and sleep at unusual times of the day, or suffer insomnia of a night-”
He interrupts me.
“My wife died in childbirth, Doctor. She never got the opportunity to even hold her daughter.”
I make a note.
Patient may have dwelt upon the misfortune of her mother – whom expired during labor, contributing to stress and anxiety during her own pregnancy. Clear precipitating factor. Unknown whether mother might have suffered from puerperal mania – the possibility remains: in which case the patient had a strong disposition towards insanity.
“Right. Mr Stanbury, did your wife display any of those signs I just mentioned during or after the pregnancy? Did she act strangely in any way, or was it only after having the child she became unstable?”
“Nothing seemed amiss until after our son was born,” he says.
“I barely saw her during her confinement, Doctor, though I hear she kept well enough.”
“How was your relationship with your wife, Mr Stanbury?” Puerperal mania has more social aspects than other forms of insanity, and I have to consider the kinship of Lady Stanbury not only to her child, but to her home and her husband.
“It was fine,” he says, crossing his arms. Despite his statement to the contrary, his body language betrays his words. I make a mental note to return to this at a later date, when I am alone with him.
Possible relationship difficulties – to follow up on this.
“How was the birth? Did she cope well?”
“She suffered badly,” Mr Stanbury says. “The doctor eventually gave her Chloroform.”
Recent research established that anesthetics can bring on an attack of insanity. My pen is now moving continuously across the cream page.
“And was there a copious amount of blood? Did she haemorrhage?”
Lord Damsbridge winces. Mr Stanbury says that he wouldn’t know: he wasn’t present in the room for the birth, and it wasn’t something he thought to ask.
Insanity appears to have developed following parturition; no marked insanity before expulsion of the baby. Pronounced emotional state may have been brought on by the pains of labor, and compounded by the intake of Chloroform. Unknown amount of blood loss, but possibly she could have become anaemic.
“How was she towards you after the birth, Mr Stanbury?”
“She was normal, at least initially she seemed to be, but as time went by she became restless. She wandered the house at night unable to sleep, checking on John constantly. Occasionally she would wake him just to check he was still breathing…” He opens his mouth to say more, but stops mid-sentence.
“Yes?” I prompt him.
“Well, that’s the thing, Doctor. She was very protective towards John. I don’t understand. How she can change from being so over-bearing and affectionate, to…” He stops and clears his throat. “To being the person to cause him harm? She worried about dirt, for heavens sake!” Tears well up in his eyes, threatening to fall, and underneath the angry exterior I see a man filled with grief, and love. He discreetly removes a handkerchief from his top pocket, and continues onwards, dabbing at his eyes. “How can she, a mother, hurt her own baby? Why?”
“Quite,” Lord Damsbridge adds. “That’s the part we don’t understand. People go insane all the time, but they don’t go around killing others, least of all their own flesh and blood.”
This is the hard part for me to explain, and I make the decision to keep it simple.
“Puerperal mania is almost always directed at the child. It is the nature of the beast, unfortunately. It is a special type of insanity. The woman in question invariably believes that for one reason or another, the child is better dead, but the mother, in these cases, is not accountable for her actions.”
“I think she damned well should be held responsible.” Mr Stanbury says..
“What, Stanbury…would you prefer your wife to be dead too?” Lord Damsbridge says, his face turning a deep shade of red. “Is that how you plan on punishing her?”
“Of course not! How dare you suggest such a thing, I simply-”
I sense this is a disagreement they’ve had before, and try to halt the situation before it develops into a domestic dispute.
“Gentlemen?” I start to rise slowly from my chair. They stop arguing, and stare at me. “I don’t wish to keep you, and I realize there have been very difficult things discussed this morning. Perhaps we do better to meet again at a future date: say, in a weeks time?”
Mr Stanbury sniffs, looking at the floor. Lord Damsbridge also remains silent.
I push my chair back.
“So, gentlemen, once again, I thank you for coming here today-”
“I would like to see her,” Lord Damsbridge says suddenly, standing and looking me in the eye. “Immediately. Stanbury,” He nudges his son-in-law; the dispute evidently forgotten or swept aside for later. “Get up. We are going to see your wife.”
“My Lord, we don’t normally allow family or friends to visit with the patients at this stage. We remove them from their home environment for good reason. I fear that seeing you both will only do her harm.”
“No, Doctor, removing my daughter from those that she loves, and placing her in a lunatic asylum, alone, compounded with the loss of her child, will be doing her ‘harm’. Seeing her father and her husband will lift her spirits, and assure her of our love for her. I would strongly suggest that our ongoing support will only serve to boost her morale.”
Spoken like a true layman. And of course spoken like a true Earl, who somehow managed to get his daughter into Bethlem as opposed to Broadmoor; where she should by rights and by law, been sent.
Evidently, he does not appreciate that her insanity alone saved her from the gallows.
“My Lord, your daughter is still suffering the effects of puerperal mania, and I fear, delusions. We could arrange a day for you to visit her, in a week or so-” I say, faltering in my attempt to reinforce my opinion.
“I demand to see her now, Doctor. It is a dreadful thought for me to imagine her re-awakening to reason inside a madhouse, side-by-side with maniacs and lunatics. I beg you not to forget who I am, or the contributions I make to this very hospital.”
I sigh. My point exactly.
“Very well, gentlemen. I do wish that I had had time to better prepare you, for I fear that you will be shocked when you see her. But if you insist.” I reach down and ring the bell on my desk. Within a second, my attendant appears, almost falling through the doorway. She quickly rights herself, smoothing her skirts and blushing.
“Nurse Ruth, Lady Stanbury’s father and husband would like to see her right away. Can you please make sure that she is ready to receive them?” I roll my eyes to the side, minutely, and she catches my meaning.
“Why, of course Doctor! Let me go and prepare her. I’ll be back in two shakes of a lambs tail!”
I sit back in my chair, gesturing for the two men to do the same.
“Here, another glass, gentlemen? In a few moments, you can see for yourself how Lady Stanbury fares.”
Lord Damsbridge refuses my offer, whilst Mr Stanbury thirstily accepts.
This time, it is I who downs my drink before he lifts his from the table.