Is Ultima Thule a literary or a literal case study?
Sue Rabbitt Roff
‘That is an excellent piece of research – very thorough and easy to read.’
Professor Brian Draper AM MBBS (Hons) MD FRANZCP
Professor (Conjoint), Discipline of Psychiatry and Mental Health
UNSW Medicine and Health
University of NSW, Sydney, Australia
Henry Handel Richardson’s first novel, Maurice Guest, was a success d’estime when it was published in Britain and Germany in 1908 but its audience grew slowly. Perhaps this was because it was a darkly romantic story about musicians in Leipzig, where Richardson herself had studied in the years after she finished her schooling in Melbourne.
The unsigned review in The Age on 10 October 1908 considered Richardson’s debut novel ‘will probably not receive sufficient recognition to repay Henry Handel Richardson for the labour and skill he has bestowed upon it. For, while the book is undoubtedly clever, it runs to the inordinate length of 512 pages, and is more like a scientific dissection of the love theme than the romance that the ordinary reader likes.’
‘Nor’ the reviewer continued ‘is the book quite healthy in tone. Stalwart manhood and womanhood are absent from its pages, which are occupied mostly in a study of the almost neurotic psychology, in which many authors seem to delight. Mr. Richardson has the ability to write healthier and brisker books, if not cleverer ones, than “Maurice Guest.”’
Not everyone agreed with this diagnosis. Less than a decade after Richardson’s death in 1946 M-G-M released Rhapsody – based on Maurice Guest. Starring none other than Elizabeth Taylor. Trailers are still available online. Lovely but too high maintenance for either of her beaux.
Henry Handel Richardson told her old school friend Mary Kernot that in writing The Getting of Wisdom after Maurice Guest the excoriating portrait of herself as a schoolgirl ‘was virtually a spreading of all ten fingers to my nose’ to the literary world into which she flung it .
Henry Handel Richardson spent the next twenty years writing the three volumes of The Fortunes of Richard Mahony. If the first two books had been her ‘prentice novels now she was ready and reconciled to writing more than a thousand pages, take as long as they might. Her husband supported her fully, financially and emotionally, in this project even to the extent of paying the equivalent of nearly current $Aust20000 to print a thousand copies of the second volume privately when commercial publishers quailed after the first sold barely three hundred copies.
Richardson acknowledged in her autobiography written in the 1940s that her father’s tragic illness and decline into dementia, dying when she was not yet ten years old, was ‘A sort of scaffolding for Richard Mahony’s story.’ During his years in the Victorian country town of Chiltern ‘my father sank into himself, and grew more and more peculiar. Patients began to look elsewhere for a doctor. Finally, after a severe illness, he was declared mentally unsound and removed to Melbourne. We saw him again only for a few months at the end of his life – a gentle, broken creature, who might have been a stranger.’
She admits ‘I can’t say we children grieved over his death. It came rather as a relief – the same relief, in an intensified form, that we had felt during his temporary absences.’ She and her sister began ‘to wall themselves up against unhappiness’. It was many years later when ‘with the help of old letters and diaries, I began to trace the shifting course of his life and the character behind it, for my work on Richard Mahony, did I grasp at least something of what he must have suffered, both for himself and for those dependent on him.’
She remembered her father as ‘a well-meaning and upright man, but so morbidly thin-skinned that he could nowhere and at no time adapt himself to his surroundings.’
Her next sentence gives us pause for thought. ‘However, I think it only fair to add that the person who knew me best always maintained that, in my imaginary portrait of Richard Mahony, I had drawn no other than my own.’
The Fortunes of Richard Mahony channels the vicissitudes of her father Walter Lindesay-Richardson, to whom the trilogy is dedicated. The third part Ultima Thule – the limits of the journey – was both a critical and a commercial success after it was selected by the recently-founded Book of the Month Club in the USA.
Henry Handel Richardson wrote of what she knew first hand in Ultima Thule, as well as what she read her in parents’ letters and diaries. The boy Cuffy is the prequel to Laura, although written after The Getting of Wisdom. We see Richard Mahony’s descent into madness through Cuffy’s eyes as much as his mother, Mary’s. Always ‘a noticing child’, HHR began to read her parents’ early letters in the year before she left Australia to study music in Leipzig.
The first two volumes had been dismissed as a somewhat prosaic chronicle in the long-life genre of Australian settler-colonial family sagas. But the story of Richard Mahony’s decline and death was the stuff of true tragedy.
By 1955, nearly a decade after Henry Handel Richardson’s death and seventy five years after that of her father, Dr Walter Lindesay-Richardson in the Yarra Bend asylum, both literary and medical commentators were remarking on the parallels between the life history as depicted in the novel and that of the author’s father. Was Ultima Thule a literary yet almost literal case study of mental illness? If so, what had caused it?
In 1955 C. H. Hadgraft, a lecturer in the Department of English at the University of Queensland, published an article boldly titled Diagnosis of Mahony. Two of the nine pages consist of a single spaced report from H.G. Wilson B.A, M.B, B.S. (Q), M.R.C.P. (Lond.), M.R.A.C.P that closely tracks the fictional Richard Mahony’s symptoms as described by HHR in Ultima Thule.
Dr Wilson concluded ‘There are only two diseases likely to cause such widespread vascular damage with such a prolonged course and, of the two, arteriosclerosis is certainly the commoner today. However, in Mahony’s lifetime, syphilis was much commoner than it is today. Syphilis, moreover, tends to occur in the younger group to which Mahony belonged; it is more likely to be associated with a widespread cerebral damage lasting for a number of years; and it is typically associated with the paranoid symptoms which appear to be stressed in places.’
‘On the other hand,’ Dr Wilson continued, ‘there is no suggestion that Mahony was likely to have exposed himself to syphilitic infection even in his youth; and there is no comment, amid a wealth of other details of his illness, regarding rashes, sores or scars to suggest syphilis as a probable cause, in the absence of the modern aid to diagnosis of the Wasserman reaction.’
He concluded that ‘Arteriosclerosis is therefore the disease from which Richard Mahony probably suffered. It will explain all his symptoms, and is virtually the only disease compatible with the rapid progress of his final illness.’
Hadgraft commented that ‘The important thing from our point of view, however, is that she (HHR) chose to depict Mahony as a sufferer from an organic malady… The cardinal fact is that the disease she describes is in its essence physical. [emphasis in original] It results from a degeneration of tissues, and lies quite beyond the control of the sufferer.’
Who, if that is the case, is not responsible for his decline into madness. Dr Wilson’s diagnosis depended on his assumption that Mahony – or Dr Lindesay-Richardson – was not denying or knowingly concealing the possibility that he had been infected by Syphilis in his medical school days in Edinburgh, or on board vessels travelling to and from Australia, or on the goldfields of Ballarat or in his practice that included attending on average at least one confinement a week.
The non-clinician Hadgraft concluded
‘The diagnosis for such a case in the 1870’s was “general paralysis (incipient).” The death certificate reads “Insanity and Paralysis.” ’
Fifteen years later, Dr Alan Stoller, Chairman of the Mental Health Authority of Victoria, co-authored an article titled The Fortunes of Walter Lindesay Richardson with Mrs R.H. Emmerson, Curator of the Charles Brothers Mental Health Museum, Melbourne. They traced through the symptoms reported for the fictional character Richard Mahony in Ultima Thule, gradually seeming to conflate him with the historical figure of Walter Lindesay-Richardson.
They concluded in 1970, nearly ninety years after HHR’s father had died, that
‘The clinical picture of general paralysis of the insane involves a progressive deterioration of health, leading to severe defects in both physical and mental aspects of the personality…. The incubation period following an initial syphilitic primary infection averages fifteen years… There can be little doubt that the clinical picture as presented in the novel is that of tabo-paresis, due to syphilitic infection of the brain and spinal cord.’
They consider ‘It is indeed a case-history’ – but whose?
The problem is that Syphilis was not confirmed as the cause of GPI until 1913 although it was suspected by the end of the nineteenth century. Dr W.H.B. Stoddard wrote in an article on General Paralysis and Syphilis: A Critical Digest in 1901 that ‘we may conclude that syphilis is so frequent an antecedent of general paralysis, that the non-syphilitic cases (if such exist) may for the present be regarded as a negligible quantity. At least, we may say for practical purposes that hardly anybody runs the risk of getting general paralysis who has not had syphilis.’
Stoller and Emmerson had published an article in the Medical Journal of Australia (MJA) a few months earlier on General Paralysis in Victoria, Australia: historical study. General Paralysis/Paresis of the Insane (GPI) is the terminal stage of Syphilis. It was one of the major reasons for admission to Australia asylums in the mid to late nineteenth century.
The literary critic Dorothy Green responded in the MJA to Stoller and Emmerson’s articles in early 1970, suggesting that Walter Lindesay-Richardson’s opposition to vaccination on the grounds that it could transmit syphilis among other diseases ’carries a suggestion that he had more insight into his own condition than is commonly supposed.’
But Green danced around the issue in her 1973 biography Ulysses Bound: Henry Handel Richardson and her Fiction in 1973. In the early pages she writes ‘The initiating cause of general paralysis is now known to be syphilis; the connection between the two would not have been known to Walter Richardson or to his contemporaries, and consequently not to Mahony; and although at the time she wrote her novel Richardson was probably aware of it, the clinical picture was far from complete.’
Green assumed that Dr Lindsay-Richardson ‘must have regarded himself as healthy by the time he married at the age of twenty-eight or so, and would have been as much bewildered by his later ill-health as were those around him.’
But she also wrote that ‘A connection between syphilis and insanity, though not specifically General Paralysis of the Insane, was suspected by Mahony’s time, for instance by Maudsley, but the one-to-one relationship was not established. Richardson’s attitude is curiously devious [emphasis added]: her narrative points in the direction of G.P.I., but the possibility that her father’s actual illness was wrongly diagnosed cannot be ruled out. She, apparently, accepted it as correct.’
Fifteen years later, in her 1988 obituary of Walter Lindesay-Richardson for the Australian Dictionary of Biography Dorothy Green states that ‘
Walter Richardson’s dementia, always incapable of proof, is now even more an open question. Nevertheless, there is no doubt that Ethel described ‘Richard Mahony’ as suffering from what she believed to be G.P.I., and that she knew it to be a tertiary stage of syphilis.’
In 2009 Professor Brian Draper of the School of Psychiatry at the University of New South Wales and a specialist in Younger Onset Dementia published a two page article ‘Richard Mahony – the misfortune of younger onset dementia’ in the MJA. He wrote ‘In Ultima Thule Richardson succeeds in providing a detailed account of the cognitive, emotional, behavioural and physical changes associated with younger onset dementia and the devastating effects it has on a young family. .. Considering Ultima Thule was published almost 80 years ago, Richardson’s accomplishment was immense.’
When I asked him in December, 2022 ‘Was Walter Lindsey-Richardson’s GPI caused by syphilis?’ he responded:
‘Definitely. GPI is always caused by syphilis – the only issue here is that in that era of pre-diagnostic testing and before the neuropathology was understood the diagnoses were entirely clinical. It is well-established that Walter Richardson had GPI. His asylum records have been examined and he had all of the features of that disorder.’
‘Of course’ Professor Draper continued, ‘in that era when Richardson was in the asylum the link between syphilis and GPI was a theory and not yet established fact and it was decades later that it was proven. Henry Handel Richardson undoubtedly based her description of Mahony’s symptoms and progression upon that research along of course with her own memories of her father’s symptoms.’
Henry Handel Richardson began writing The Fortunes of Richard Mahony in London just as the aetiology of Syphilis and its progression to GPI was confirmed on the eve of the outbreak of the First World War.
Professor Draper explained ‘Syphilitic dementia is specific – it is the late effects of untreated syphilis on the brain that comes on some years after the initial infection. Indeed, it was the establishment of the link between syphilis and insanity & dementia that was one of the major factors that demonstrated that forms of insanity and dementia had underlying physical organic causation and were not just a psychological disorder.’
He commented ‘I cannot see how anyone can dismiss neurosyphilis as the basis for either Walter Richardson’s insanity or Richard Mahony’s illness. There are of course other psychological issues at play, but these are either a reaction to or interacting with the neurosyphilis and its inevitable decline. Just like in people with dementia today. And novelists will of course explore these issues to broaden the messages being conveyed – that is certainly the case in Ultima Thule.’
The question arises: What did Dr Walter Lindesay-Richardson know about Syphilis?
Henry Handel Richardson’s father died on the thirtieth anniversary of his graduation from Edinburgh of University Medical School in 1849. It was reported in the Journal of the Royal College of Physicians in Edinburgh in 2012 that ‘From the late 1840s onwards, GPI was commonly diagnosed in Scotland’s main cities, particularly in Edinburgh.’
In June 1855 the thirty year old Lindesay-Richardson wrote in one of his many letters to his nineteen year old fiance that ‘when at college (when all young men go thro’ a little studying and a great deal of what they fancy is fun [emphasis in original]. Late hours &c impaired my health…’
A few sentences on he writes ‘ Of course dearest, every man and woman have (sic) faults, blemishes, imperfections of body and mind, but we must remember there is no perfect one, and remembering this we must forgive..’ [emphases in original]
Six weeks later he was assuring Mary, four months short of her twentieth birthday, on the eve of their marriage that ‘my health is excellent.’
Three months into their engagement he was signing his letters ‘Your ardent lover.’ It is clear from their letters over the next twenty years that he and his wife were strongly attracted sexually.
Dr W Lindesay-Richardson practised as a general practitioner with a special interest in Obstetrics and Women’s Diseases in England and Victoria. He left England a year after an incident in May 1852 where he was reprimanded by the Board of Guardians of Bromley for ‘great neglect’ of a patient, though this does not necessarily mean that the professional criticism was the cause for his departure. He wasn’t registered to practise in his first four years in Australia until December 1856.
He spent those years trying to make his fortune on the goldfields at Ballarat, warning his fiance that his general store was pitched among the ‘riff raff’ who were his customers.
In August 1862 Walter wrote ‘ I have been almost delirious all day with this blessed ‘Tic’…. I never had a moment’s intermission from pain until about 6 when it abated a little. …My face is paining me not a little it is not toothache but genuine ‘Tic doloreux.’’ [emphases in original] This facial tic is associated with Syphilis among other conditions.
Dr Lindesay-Richardson published an article in the first 1864 issue of the MJA. At page 60 there was an item from France reporting a suspected case of syphilis in a recently vaccinated child.
Seven pages on, in reports from the Medical Society of Victoria, there was a ten page article ‘On the General Paralysis of the Insane’ (GPI) by Thomas Allan, Resident Surgeon at the Yarra Bend Institute Asylum where Dr Lindesay-Richardson would be committed nearly 15 years later with a diagnosis of GPI. There was no mention of Syphilis in this article.
Since these articles were bound in the same printed volume of the MJA as his article on empyema, it would seem very likely that Henry Handel Richardson’s father read these 1864 reports.
When Lindesay-Richardson returned to London in 1867 he wrote the first of several Letters from Home to the MJA (also referred to frequently as the Australian Medical Journal.) He was interested in Homeopathy and Skin Diseases as well as current practice in other areas of Medicine. In August 1867 he noted of the Homeopathic Hospital in Great Ormond Street that ‘All cases are admitted except diseases supposed to be contagious, as scarlatina, small-pox, typhus, &tc.. I saw a case of secondary syphilis, with mucous tubercles’ that was being treated with mercury.’
The next month he reported ‘I am happy to inform you that the filthy practice of syphilization has not made any progress; its chief advantage being that it stopped the mercurial plan of treatment… The general belief now is that like other specific diseases, small-pox, scarlatina, &c, the system is not liable to a second attack, except, perhaps, at periods of long intervals.’
In December 1867 Lindesay-Richardson’s Letter from Home in the MJA contained his observation that forty per cent or more of diseases of the skin that he had observed in a Paris hospital were syphilides cases – cutaneous eruptions due to syphilis.
Two months later he wrote ‘I mentioned in my last that I had been surprised, during a recent visit to Paris, to notice the amount of syphilitic diseases that presented themselves for treatment in the public charities there. It appears that we are nearly as bad in England’ – where major London hospitals were treating forty to fifty percent of their patients for syphilis. An extension of the British Contagious Diseases Act of 1866 beyond areas around military encampments sought to decrease the number of female sex workers with venereal diseases including syphilis.
In 1874 Dr Lindesay-Richardson published a long letter in The Harbinger of Light headed ‘The Position of the Anti-Vaccinators.’ He was worried about smallpox and other diseases being transmitted by the material taken from one body and injected into another. He specifically refers to Syphilis, reporting that
‘Mr Ballard, in an excellent work, published in 1868, says “there are cases on record in which it is difficult to arrive at any other conclusion than that the virus of the vaccine, and the virus of syphilis, were both taken by the vaccinator out of a vaccine vesicle; which presented at the time all the characteristics of a perfect vaccine pock.” It must be admitted that as the case stands at present, the evidence points only to the possibility [emphasis in original] of the syphilitic or other poison being communicated.’
Lindesay-Richardson was not alone in this view and there is a growing correspondence even in the Owens and Murray Advertiser by 1881. But that was more than two years after HHR’s father’s death in Koroit, after he had walked out on his general practice at Chiltern because of concerns, among others, about the safety of the vaccinations he was required to deliver to his patients.
In 1868 while he was in Britain Lindesay-Richardson may have read Dr G.H.B. Macleod’s article on the state of knowledge about Syphilis and its treatments in the April issue of the Glasgow Medical Journal. He might have been startled by Dr Macleod’s statement that ‘It is very questionable whether in any case syphilis is ever wholly eradicated. Vidius says it “makes truces, but never peace.”’ Even when the symptoms seem to have disappeared.
The same newspaper reported in 1877, a year after he took up practice in Chiltern that ‘Dr Richardson, public vaccinator at Chiltern, recently resigned that appointment, so that the people of Chiltern now have no means of having their children vaccinated. In a letter to the local newspaper Dr Richardson has expressed rather an unfavorable opinion as to the advantages of vaccination, and as he is opposed to it it is scarcely likely that the Chief Medical Officer will decline the resignation.’
The Chiltern Federal Standard regularly carried advertisements offering consultations with a doctor who specialised in the treatment of Syphilis
By February 1877, barely nine months after he had taken up the practice in Chiltern, Lindesey-Richardson wrote to his wife ‘I am sure we will not and cannot remain here, the practice is gone, & is now a farce – there is no money, & no sickness!’…. I am very anxious & uneasy about you & the dear ones & am wretched about the future – I don’t think I shall ever be an old man for I feel myself getting more feeble every year, and the worries & anxieties of life make me very anxious to go.’ [emphases in original]
In August 1877 he went to Melbourne to consult with his friend of nearly twenty years, Dr Graham, about what sort of practice he should look for now he was abandoning Chiltern. There was a large widely-spread practice at Clunes ‘but Graham does not think I could overtake the work at Clunes.’
He dithered about taking up a practice at Queenscliff because Mary – who was packing up in Chiltern, with Dr Graham’s wife for support – preferred Clunes. Lindesay-Richardson wrote to his wife tetchily ‘I again think that I am not able for Clunes. Graham said so – My poor head would soon give way & having to pay for a substitute after 4 hours would simply be ruin… I cannot do impossibilities, & I feel that I am an old broken down man.’ He was fifty two years old.
Queenscliff, he told Mary, ‘will be a quiet practice & there would be no risk of breaking down by overwork as at Clunes; the one would lead to strength and the other to the Benevolent Asylum – Why don’t you ask Mrs Graham?’
He swithered for a couple of days, apologising to Mary ‘I must have been a little wrong in my head when I telegraphed.’
Dr Lindesay-Richardson published two Extracts from my Common Place Book in The Harbinger of Light in mid-1878, weeks before his commital to Cremorne hospital just under a year before he died. In the first he included a quotation from Maudesly’s 1871 book, Body and Mind. ‘No one can escape the tyranny of his own organisation, no one can elude the destiny that is innate in him even when he believes that he is determining them with consummate foresight and skill.’
Maudesly wrote elsewhere in the book that ‘The virus of smallpox or syphilis marks its mark on the constitution for the rest of life.’ He observed that ‘Syphilitic disease of the brain or its arteries lands one person in the asylum with mental symptoms predominant, another in a hospital with sensory and motor disorder predominant.’
But in 1870 Maudesly acknowledged that ‘It is obvious that we learn very little of value from an account of the treatment of mania generally when there are included under the class diseases so different as puerperal mania, the mania of general paralysis, syphilitic, epileptic, and hysterical mania, each presenting features and requiring treatment in some degree special.’
The aetiology of GPI originating in Syphilis wouldn’t be confirmed for another forty three years.
Despite the best efforts of his wife and his medical friends who got him Acting Positions as Health Officer and Tide Surveyor, in September 1878 Dr Lindesay-Richardson was admitted to Cremorne Private Hospital in Richmond almost a year to the day that he took up the Queenscliff practice.
Walter Lindesay-Richardson’s biographer, Bruce Steele, wrote in 2013 that ‘In 1912 [33 years after her father’s death], HHR visited friends who had known the Richardsons in Queenscliff. They recalled that he would put his head down on Mary’s breast and weep and say ‘Mary what is it? What is the matter with me? Why am I like this?’ The diagnosis of incipient General Paralysis of the Insane was well documented at the time, but the cause was not firmly established as tertiary syphilis until almost 50 years later. This may account for Walter’s expressed ignorance of the cause of his condition.’
Steele transcribes the record of admission in the Yarra Bend Asylum Admissions Book from Cremorne in November 1878:
Cause of insanity … blank..
Form of insanity …. Gen. Paralysis (incipient)
A fortnight after Dr Lindesay-Richardson’s death sixteen months later the MJA published an obituary noting his considerable strengths and achievements but also reporting that
‘after a while he found himself under the necessity of starting life again, with the bitter consciousness that if he could have foreseen the coming evil, he might have provided against it. This reflection probably had much to do in the production of that mental disturbance from which he latterly suffered, and which necessitated his being placed under treatment for it. He had previously tried various localities for practising after leaving Melbourne, but, like many other men in like circumstances, misfortune, having once marked him for her own, refused to leave him, and he did not succeed in any of them. He had qualities which ought to have given him a leading position in the profession of medicine, but unquestionably circumstances were against him, and his over-sensitiveness hindered him from fighting against adversity. He was a man whose intelligence and bonhomie at once made friends of those with whom he came into association, and if, during the last few years of his life, he did not always maintain the friendly relations he had formerly established, it is easy, remembering the clouds which for some time had been gathering over him, to explain the reason.’
How did Henry Handel Richardson ‘recreate’ Richard Mahony’s illness?
The narrative – or scaffolding – of Mahony’s Fortunes is directly taken from the more than a hundred letters between HHR’s parents. The trilogy is nearly a thousand pages long and we can see how skilfully HHR developed the story and characters. For instance, Walter had written to Mary that they must go to Queenscliff rather than Clunes because their friend Dr Graham had advised that it ‘the one would lead to strength and the other to the Benevolent Asylum – Why don’t you ask Mrs Graham?’
In Ultima Thule Richard Mahony writes to his wife:
‘FEELING VERY LOW THE OTHER DAY, I WENT TO GEELONG AND SAW BOWES-SMITH WHO VISITS THERE; AND IT WAS HIS OPINION THAT I SHOULD BE TOTALLY UNFIT TO COPE WITH THE WORK AT NARRONG. WHICH BUT CONFIRMS MY OWN. OF COURSE, AS YOU ARE SO SET ON IT, I MIGHT TRY IT FOR THREE MONTHS—ALONE. BUT I CANNOT DO IMPOSSIBILITIES, AND I FEEL MORE AND MORE AND THOUGH I HAVE SAID NOTHING ABOUT IT, I HAVE BEEN SENSIBLE OF SOME UNPLEASANT SYMPTOMS OF A RETURN OF THIS, ON MORE THAN ONE OCCASION SINCE. MY AFFECTION, WHICH WAS APHASIA, MAY COME ON AGAIN AT ANY TIME. IT MAY ALSO END IN…WELL, IN MY BECOMING A HELPLESS BURDEN…TO YOU AND EVERY ONE. NOTHING CAN BE DONE; THERE IS NO TREATMENT FOR IT BUT A TOTAL ABSENCE OF WORRY AND EXCITEMENT. SO IF YOU REGRET NARRONG, YOU MUST FORGIVE ME; IT WAS DONE FOR YOUR SAKE.
Polly eventually confronts Dr Bowes-Smith in Chapter 5 of Ultima Thule to ask what is wrong with her husband. ‘Ignoring her blunt question: “But if it isn’t true apoplexy, then what is it?” Bowes-Smith proceeded deliberately to catechise her.
“I don’t know, Mrs. Mahony, whether you are…h’m…whether it is…er…news to you that I saw your husband some two or three months back? He…er…consulted me, at the time, with regard to…h’m…to an attack…nay, to recurring attacks of vertigo. I found him then under no…h’m…no delusion as to his own state. He said nothing to you? Did he not take you into his confidence?”
HHR confined her ‘creative non-fiction’ within the parameters of what was understood in the 1870s about General Paralysis of the Insane. But she began writing just as it was confirmed that GPI was tertiary Syphilis, on the eve of the First World War. She wrote it in London, in a home where her nephew Walter Lindesay Neustatter was studying first for a psychology degree and then for his medical degree, which he gained in 1929 just as Ultima Thule was published.
In 1957 Neustatter recalled visits in the 1920s from Grace Maudsley, widow of Australian doctor Sir Henry Maudsley – a nephew of Dr Henry Maudsley of Body and Mind who founded the Maudsley Mental Hospital where Neustatter was trained for a distinguished career as a forensic psychiatrist. But HHR never explores the implications of Dr Lindesay-Richardson’s aka Dr Richard Mahony’s attendance at nearly 700 maternity cases recorded in his Casebook, or his apparent lack of protection for his own sexual partner. She wrote at the end of her life ‘I saw him then as a well-meaning and upright man.’
Henry Handel Richardson said she thought biography should be written with ‘every wart and every pimple emphasized, every murky trait or petty meanness brought out.’ But in the event she seems to have found, like Elizabeth Jolley, that ‘Writing fiction is not easy, to write the facts is almost impossible.’