Fiercombe Manor (43 page)

Of the two types of puerperal insanity, the melancholic variety seems to be the more insidious, hovering like a spectre for many months, sometimes years. It is this type that is least likely to be cured and most likely to return. Mania, while distressing in the extreme for the loved ones of the sufferer, with women of previously excellent character observed shouting, stamping, screaming, swearing, and otherwise lost to a state of high phrenzy, is eminently curable. Of course, either path is a painful one for all concerned, particularly at a time that should be marked with joy.

From my own observations, puerperal insanity—as well as the related conditions of insanity during pregnancy and insanity brought on by problems with lactation—is as likely to afflict the woman of high as low rank. That is not to say their treatments should be similar. While a woman of very poor means will gain much from a month's sanctuary in an asylum, where she will likely be better fed and rested than at home, a place of respite rather than cruel exile; a woman of better breeding is better cared for at home. If she must be separated from her loved ones, the private asylum must be carefully chosen, so as not to make the most damaging kind of lingering melancholia a more likely, and permanent, outcome.

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I have been the family physician of the Stanton family, of Fiercombe Manor and more recently Stanton House, for many years. As a much younger man I helped safely deliver Sir Edward (as he would become) and his brother. The tradition had continued and in the autumn of 1893 I was called to attend the first labour of Sir Edward's wife, Lady Elizabeth Stanton. She gave birth to a baby girl, and while Sir Edward was perhaps a little disappointed not to have a son, the child was healthy and Lady Stanton seemed exhausted but overjoyed.

A week or so later I was called again to the house and found its mistress quite altered. The contrast was stark—a calm, radiant happiness replaced by someone at first coldly unresponsive and later increasingly agitated and disturbed. She would—or could—not sleep and refused all food. The child she showed absolutely no interest in, which is common in these cases. I would go further: she did not seem to recognise or acknowledge any kind of personal connection to the infant at all. This was different in the extreme from another case that I shall presently come to, of a woman of comparatively poor means, residing in Painswick.

I last attended Lady Stanton about three weeks after the birth and was helpless to halt or even alleviate her symptoms, which only seemed to worsen. She seemed, even as I watched, to turn inwards upon herself. Her lips moved constantly in silent prayer or song, the words only occasionally audible above her shallow breathing. I have found that relatively little can be done to affect a quick cure in these cases; complete rest and a withdrawal of circumstances that might over-stimulate the patient's fragile mind and worsen the hysteria that has already taken hold are doubtless the best (and perhaps only) remedies. In some cases resembling
this one, I have found that light purgatives and nutritious tonics offer some relief, though not in this instance.

My private belief in this case was that Sir Edward's distress at and frustration with his wife's condition—something borne of fear but that showed itself in anger—served only to heighten and prolong it. Though Lady Stanton seemed entirely oblivious to what was around her, I felt sure she could sense what I can only describe as the vibrations of the air in that house, which was an increasingly unhappy one. I confided to Sir Edward as I left Fiercombe Valley for the last time—though I was not to know it was the last time until I received a note asking me not to call again and enclosing a cheque to pay my bill—that it might be less injurious to Lady Stanton if she were to be sent away, perhaps to the house of a trusted family member, until she was quite recovered. I still fervently believe that the close, stifling atmosphere of Stanton House only hindered Lady Stanton's progress, producing in her a kind of claustrophobia. This, in my opinion, simply augmented her insanity, which soon progressed from a clouded and rather vacant disposition to something closer to mania, culminating in her attempts to harm herself and her child.

In fact, a subsequent doctor from outside the county advised a similar method of cure, though I believe—through hearsay only, sadly my ties with the Stanton family are severed completely—that it was an institution she was taken to, by a third physician, rather than the peaceful, familiar place I would have recommended for her. Still, it is said that it cured her. Certainly she survives. Not much is heard of Sir Edward and particularly Lady Stanton these days, indicating that she has not entirely recovered her previous spirits, but she was able to return before Christmas last year, having come through her ordeal. It is said in the village that she is belatedly close to her small daughter.

Whether Lady Stanton would suffer similarly if she were to have another child is not easy to predict. If I were asked, though it is with great sadness that I know I shall not be, I would say, taking into account all her circumstances—her husband's tendency to anxious anger, the underlying need for an heir—as well as what must be a natural, ingrained tendency of her mind to be so afflicted, that she would likely be wrenched under again. I hope I am wrong in that.

Wrenched under
. In that generally factual account of what must have been a significant medical case for Frith, the phrase had a raw power. I wondered if it had also had prescience too. I put the sheaf of papers down for a moment and thought about how the man who had written them had been here, in this same valley, visiting her when she was still alive.

I had been too engrossed in my reading to notice, but the wind had grown fiercer, the unsecured casements juddering back and forth in the old frames. I got up carefully, my arm supporting the baby's weight, and closed them firmly. Outside, the yew pylons continued to sway. I thought about going downstairs and apologising to Mrs. Jelphs for making her worry, but I was drawn back to the rest of the papers on the bed.

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Above I made mention of an ordinary village woman from nearby Painswick. This was one of the more extreme cases of puerperal insanity I have attended, some years ago now, in 1876, though I am glad to say that the patient, who I have been able to examine thoroughly many times since, made a complete recovery. Interestingly, and perhaps hopefully for those like Lady Stanton, this woman had given birth to two children uneventfully, with
no evidence of mania or even a mild depression of spirits, either during the pregnancy or in the crucial days and weeks following both labours.

Janey Litten was struck down with a very serious case of puerperal mania two days after the birth of her third child—also her first daughter, though I believe the sex of the child to be neither here nor there in these cases.

I broke off reading and then read the name again, feeling such a jolt of shock that the writing on the paper seemed to shift and tilt for a moment. Janey Litten. My grandmother's name. I thought of Hugh Morton's hesitancy before handing the papers over to me, but knew that he could only have been thinking about my own impending labour and the circumstances surrounding Elizabeth's illness. The chances that he had connected me to someone named Litten, or had even read further than Elizabeth's case, was so slender as to be negligible. With a second jolt that made my heart hammer painfully in my chest, I realised that the child mentioned—the third child, the first daughter—was my mother.

I pieced together what I remembered of my mother's mother—which was not a clear picture but something closer to a melding of senses: the waft of her lavender scent, her cool hands over mine, dusted with flour, as she showed me how to rub slippery yellow butter into flakes. I could still hear the soft timbre of her burred voice, though not the actual words she spoke, and I could still taste the toast she made for me and remember how the bread's edges blackened and frilled as I watched. As all this came back to me in a rush, I began to cry, an effect her memory had always had on me, like turning on a tap; a great welling of loss inside me.

I couldn't remember when I last saw her, though I knew my mother had said I was too young to attend her funeral—as well
as my grandfather's, which took place not long after. My uncles had moved away at some stage, to Bristol perhaps, I wasn't sure. I wished I could go to Painswick and search for her gravestone, and those of my grandfather and other Littens too.

One of my tears fell and spread on the papers I still held, blurring the word
mania
. I was glad to see it marble into something unintelligible. I knew I should put them away—no, burn them—before I read on, but even as I resolved to do so, my eyes searched for the next sentence.

The infant girl, as in the case of Lady Stanton's child, was a healthy one, and the family was at first relieved. Mrs. Litten had endured the births of her two boys—both large babies—with fortitude, but it was physically a blessing that this child was two pounds smaller, though no less hardy. “That'll do for me now, Doctor,” I remember Mrs. Litten saying to me.

As is still fairly common in the countryside, I had not attended the birth itself, only checked on the mother and child after, the local midwife being present for the duration of the labour itself. There are many who seek to banish these traditional practices, but I cannot see harm in them and think this but a fashion, as all things are subject to, even medical theories, it seems. I have witnessed no rise in cases of puerperal insanity when a midwife has attended rather than a physician. To my mind, the female mind is always vulnerable to disturbance when in confinement, and whether this turns to insanity is unexplainable, and some combination of many causes, from an inherited nervous tendency to an excess of unrelieved pain in the labour itself.

In the case of Janey Litten, I should mention that she had also suffered a miscarriage between her second and third confinements. This took place some six months into the
pregnancy. I examined her myself after this, and she was much saddened, but only to a degree one would expect, perhaps a little more withdrawn, and for longer than some—she was not herself for a year or more—but nothing I believed was untoward.

With the new infant, she was much changed from the third day. Her relief on having been able to carry the child to term seemed to quickly grow into a restless sort of excitement. She claimed she could hear things, whisperings and rustlings, and after a week had passed, the symptoms clearly worsening, she appeared to be lost in conversation with someone conjured up by her own, increasingly disturbed mind. In this state, she was quite uncanny to observe: apparently listening intently and then erupting into laughter or exclaiming that she couldn't or mustn't, shaking her head in a highly agitated manner. Normally of a quiet, gentle disposition, she was utterly altered, and was heard to shout out often in what her husband called “a most bawdy manner.” On one occasion, she was suspected to have bitten the infant, and on two occasions was seen violently shaking her when she cried.

John Litten was so much disturbed by his wife's behaviour that he asked that she go to the asylum at Wootton and would hear no arguments to the contrary. Such was his fear of her mania, and what he believed were her “crafty” intentions to injure him and their children, that I felt it would do the family more harm than good for her to remain in the family home. She was well nourished enough, but I reasoned that the rest an asylum could offer her outweighed the benefits of her staying close to her family. It is best if women like this do not receive visitors while they are confined in an asylum. Once there, they are much better cared for by trained nurses and physicians with whom they are unfamiliar.

Mrs. Litten returned to the family home after a seven-month
stay, after which time she was quite back to her usual peaceable demeanour, with little or no memory of what had passed. The infant, known as Maggie, also survived with no visibly lasting ill effects.

I stopped reading and let my head fall back against the oak headboard of the bed. The child inside me, now just weeks from being born, rose hugely above the sheets that I'd smoothed down that morning. I seemed to have got bigger in a single day and felt more ungainly by the hour. There was no escaping the fact of my condition, let alone the physical discomfort that came with it. Now the imminence of it all was freighted with extra significance.

I looked down at the old papers beside me on the bed. They contained secret information about—along with a dozen other women who meant nothing to me—not only the elusive Elizabeth Stanton but my own grandmother. What would have made disturbing reading at any time was multiplied many times by the fact of my pregnancy. When I put this together with Fiercombe's seemingly tarnished history and the way Mrs. Jelphs often looked at me, I really did feel doomed. However sensational that sounded, no other word did justice to my feelings. Not only was I trapped in the disquieting atmosphere of the valley, already half wondering if it was turning or haunting my mind, but I was also becoming increasingly certain that I had inherited a predisposition to madness after giving birth.

Feeling a swell of panic rising inside me, I got to my feet and immediately caught sight of the pieces of rubble of Stanton House that I had put in my pocket unthinkingly, all those weeks earlier. They had been pushed to the back of the dressing table and obscured until now by a clutter of pins and combs and pencils. I picked them up, suddenly aware that I wanted to be outside, even
if it meant being buffeted by the wind that had now found a fingerhold in the old casements and was whining to be let in. I stumbled through the door and down the stairs.

Mrs. Jelphs wasn't in the kitchen when I got there. I hoped that she wouldn't go upstairs to look for me and see the papers that I'd left strewn all over the bed. The door was rattling slightly in its frame as I opened it, and I felt it almost sucked out of my grasp as I lifted the latch. I looked up, but there were no distinct clouds, only a sky that was clear but glowering, no longer celestially blue but lowering to violet.